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DISEASES  OF  MAN: 


DATA  OF  THEIR 


NOMENCLA  TURK,  CLASSIFICA  TION  &^  GENESIS. 


To   DESCRIBE  IS  TO    PARTICULARISE. 

"  Words  are  the  fortresses  of  thought." 
"  In  words  are  contained   the   sciences   possessed   by  the 
nations  of  the  earth. ..." 

To   DEFINE   IS  TO   GENERALISE. 

Definition  is  the  summary  of  description. 
"  Perfect  definition  is  the  summit  of  human   knowledge   in 
every  part  of  science " 

"To   NAME  IS  TO    KNOW." 

"  The  true  progress  of  science  must  always  be  realised  in 
names." 

"Things  are  known  when  understood  and  are  understood 
when  interpreted." 

"The  perfection  of  a  science  depends,  in  no  inconsiderable 
degree,  upon  the  perfection  of  its  language;  and  the  perfec- 
tion of  every  language  upon  its  simplicity  and  precision." 

"To   THINK   IS  TO   CLASSIFY," 

and  to  classify  is  to  think. 

"  System  is  the  Ariadnean  thread  without  which  all  is  con- 
fusion." 

"  Classification  is  not  attainable  by  art  only,  it  requires  a 
mind  that  is  capable  of  distinguishing  things  by  their  specific 
differences  ;  not  separating  things  that  are  alike  nor  blending 
things  that  are  different." 


DISEASES  OF  MAN: 


DATA    OF    THEIR 


NOMENCLATURE,  CLASSIFICATION &<»  GENESIS. 


BY 


JOHJST  ^Sr.  S.  G^OUILi:E Y,  M.  D., 

Surgeon  to  Bellevue  Hospital. 


NEW  YORK : 
J.  H.  Vail  &  Co.,  2 1  Astor  Place. 

LONDON: 

H.  K.  Lewis,  136  Gower  Street. 

1888. 


Copyright,  1888. 
By   J.   W.    S.    Gouley. 


PREFACE. 

The  objects  of  this  book  are  ;  first,  to  urge  the 
official  adoption  of  a  stable  basis  for  the  nomen. 
clature  and  classification  of  the  diseases  of  man ; 
second,  to  place  before  the  medical  profession 
certain  propositions  directed  to  an  improved 
classification  of  diseases  ;  and  third,  to  awaken 
the  attention  of  teachers  to  the  necessity  of 
ameliorating  the  nomenclature  of  medicine, 
pointing  out  some  of  the  many  misused  and  im- 
properly formed  words  that  are  now  current, 
and  proposing  new  terms  for  their  considera- 
tion. 


6  PREFACE. 

In  attempting  to  classify  the  affections  of  the 
male  urogenital  apparatus,  it  was  found  diffi- 
cult to  do  so  satisfactorily,  owing  to  the  defects 
of  the  existing  nomenclature.  This  led  to  an 
inquiry  into  the  former  and  actual  state  of  nos- 
onomy  and  nosotaxy,  and  into  the  methods  em- 
ployed by  nosographers  from  the  time  of 
Sauvages  to  the  present.  The  conclusion  ar- 
rived at,  is  that  a  nomenclature  and  classification 
to  be  useful  and  stable  should  not  only  rest 
upon  a  proper  foundation,  but  should  be  duly 
authorised  by  the  whole  profession  of  medicine. 
The  principles  deduced  from  an  analysis  of  the 
methods  of  nomenclators  and  classifiers  are  now 
submitted  to  the  profession  ;  and  certain  ques- 
tions are  suggested  for  discussion  in,  and  for 
settlement  by,  the  International  Medical  Congress 
which  properly  represents  the  medical  profes- 
sion. 

The  presentation  of  this  subject  to  the  profes- 
sion is  designed  as  a  plea  for  the  more  systematic 


PREFACE.  7 

study  of  diseases,  and  as  an  individual  protest 
against  their  existing  nomenclature  and  classfica- 
tion,  with  the  hope  that  this  protest  will  become 
general  among  teachers  and  others  who  realise 
the  necessity  of  bettering  the  condition  of 
medicine,  without  undertaking  to  destroy  its 
fabric  in  order  to  reconstruct  it ;  but  rather  to 
modify,  simplify,  and  improve  it  by  gradually 
substituting  exact  terms  for  those  that  have 
never  conveyed  correct  ideas. 

During  the  preparation  of  this  book,  more 
or  less  frequent  consultations  were  held  with 
Doctors  Clymer,  Carroll,  Flint,  Biggs,  Cronyn, 
Taylor,  Clark,  Leale,  Grauer,  John  Shrady, 
Edmund  Arnold,  and  others.  The  valuable  sug- 
gestions of  these  kind  friends  are  gratefully 
acknowledged. 

Botanists,  Mineralogists,  Biochemists  and  Phi- 
lologists have  been  consulted  with  much  advant- 
age and  their  hints  have  been  thankfully  received 
and  carried  out. 


8  PREFACE. 

Works  on  Botany,  Zoology,  General  Chemis" 
try,  Biochemistry,  Physiology,  Descriptive  Anat- 
omy, General  and  Special  Pathology,  and  Sur- 
gery, and  many  of  the  treatises  on  nomenclature 
and  classification  have  been  freely  used.  A 
general  acknowledgment  is  made  to  the  authors 
of  these  works  which  have  been  of  the  greatest 
service  in  this  endeavor  to  elucidate  the  princi- 
ples of  nosonomy  and  nosotaxy. 

324  Madison  Avenue, 
New-York,  January  1888. 


CONTENTS. 

PREFACE, page  5-8 

CORRIGENDA, "       I2 

INTRODUCTION "13-24 

SECTION  I. 

Preliminary  Considerations. 

Outline  of  the  anatomical  view  of  man.  Definition  of  med- 
icine. A  classification  of  the  science  and  art  of  medicine. 
Medicine  and  Surgery.  Arrangement  of  medicine  into  certain 
departments  in  accordance  with  the  apparatuses  of  the  humaa 
body.  The  physician.  Definition  of  disease.  A  synopsis  of 
the  morbid  states  and  morbific  processes  of  the  body.  The 
value  and  significance  of  proper  anatomical  terms  in  classi- 
fication. Definition  of  system,  organ,  apparatus,  and  function. 
Systems  and  organs  perform  no  function,  but  yield  service  to 
apparatuses.  Each  apparatus  performs  only  one  function, 
and  there  is  no  function  without  an  apparatus,    .     page  25-72 


lO  CONTENTS. 

SECTION  II. 

Human  Nosography. 

A  summary  of  the  progress  of  nosography  since  its  founda- 
tion. The  scope  of  nosography.  Notice  of  Sauvages.  A 
consense  of  views  necessary  in  methodical  arrangement. 
Synopses  of  Sauvages'.  Cullen's,  Parr's,  Good's,  and  Delorme's 
arrangements  of  diseases.  Comments  on  these  several  sys- 
tems. Cullen's  rules  for  distinguishing  genera,  species,  and 
varieties  of  diseases.  Parr's  rules.  Some  of  the  aphorisms, 
relating  to  classification,  extracted  principally  from  the  phil- 
osophia  botanica  of  Lmnaeus,  by  Dr.  Thomas  Young, 

page  73-199 

SECTION  III. 

NOSOGRAPHICAL   BIBLIOGRAPHY. 

A  chronological  list  of  the  works  on  nosography  that  have 
appeared  from  the  time  of  Felix  Platerus  to  the  present, 

page  200-2 1 1 

SECTION  IV. 

Basis  and  Method  of  the  Classification  and 

Character   of   the    Nomenclature    of 

THE    Diseases   of    Man. 

Many  high  authorities  opposed  to  classification.  To  think 
is  to  classify.  Characteristics  of  good  classifiers.  Modem 
classifiers  use  terms  of  classification  arbitrarily  without  taking 
the  pains  to  define  these  terms.  Nosography  on  the  basis  of 
symptoms  misleading  and  retrogressive.  Anatomy  the  only 
stable  basis  for  nosography.    Description  and  definition  of  dis- 


CONTENTS.  II 

eases.  Methods  of  the  nosographer.  The  use  of  the  dead 
languages  in  nomenclature.  The  names  of  men  should  not 
be  applied  to  diseases.  Suggestions  for  an  improved  classifi- 
cation of  diseases.  A  consense  of  views  necessary  in  the  use 
of  terms  of  classification.  Questions  suggested  for  discussion 
at  the  Tenth  International  Medical  Congress.  Definitions  of 
the  terms  of  classification page  212-252 

SECTION  V. 

Review  of  the  Morbid  States  and  Morbific 

Processes.    The  Bacteria.  Ptomaines, 

Leucomaines,  and  Extractives. 

Analysis  of  some  of  the  terms  used  in  general  pathology 
and  of  those  contained  in  the  synopsis  of  morbid  states  and 
morbific  processes,  together  with  remarks  on  these  states  and 
processes.  Summary  of  the  present  state  of  knowledge  of 
the  bacteria,  ptomaines,  leucomaines,  and  "  extractives." 
The  relations  borne,  to  medicine  and  surgery,  by  these  micro- 
organisms and  alkaloids  of  putridity.  Classifications  of  the 
bacteria,  ptomaines,  and  leucomaines.  Uniformity  in  their 
nomenclature  and  classification  much  needed.  Remarks  on 
the  neoplasams  and  on  their  classification,     -      page  253-379 

CONCLUSIONS "  380 


CORRIGENDA 

Page    36,  second  line,  for  propylactic,  read  prophylactic. 

40,  foot  note,  for  celibary,  read  celibacy. 

48,  V.  8,  for  (obsteoma),  read  (osteoma). 

56,  foot  note,  for  eyyEvrjiy  read  EyyEviji. 

63,     "       "      for  opyavov,  read  opyavov. 

67,  tenth  line,  for  antonomous,  read  autonomous. 

69,  fifth  line  from  bottom,  for  corect,  read  correct. 
102,  IX.  L,  for  sangninfluxus,  read  sanguifiuxus. 
150,  fourth  line,  for  cornea,  read  cornea. 
212,  first  line,  for  authorites,  read  authorities. 
255,  foot  note,  for  t'ltoy  read  V7t6. 

365,  third  line  from  bottom,  for  oDoii,  read  aodii. 
For  Laenec  read  Laennec. 


13 
INTRODUCTION. 


I.  This  book  is  divided  into  five  sections.  The 
first  section  comprises  :  some  anatomical  consid- 
erations of  the  normal  human  body;  a  statement 
of  the  objects  and  scope  of  medicine  ;  a  classifica- 
tion of  medicine ;  the  mutual  relations  of  medi- 
cine and  surgery  ;  an  arrangement  of  medicine 
into  departments  in  accordance  with  the  appara- 
tuses of  the  human  body ;  the  definition  and 
genesis  of  disease ;  a  synopsis  of  the  morbid 
states  and  morbific  processes  of  the  body,  de- 
signed as  a  suggestion  of  a  ground-work  for  the 
classification  of  diseases;  and  an  analysis  of  some 
of  the  anatomical  terms  used  in  classification. 
The  synopsis  of  morbid  states  and  morbific  pro- 
cesses stops  at  genera,  but  a  few  species  are  given 
in  foot-notes. 

The  second  section  relates  to  the  history,  de- 
velopment, scope  and  significance  of  human 
nosography,  and  contains  synopses  of  a  considera- 
ble number  of  systematic  arrangements  of  dis- 
eases, illustrative  of  the  principles  of  nomencla- 
ture and  classification,  and  also  rules  for  the 
guidance  of  nosographers  by  Cullen,  Parr,  Young 
and  Linnaeus. 


14  INTRODUCTION. 

The  third  section  consists  of  a  nosographical 
bibliography,  chronologically  arranged,  from  the 
time  of  Felix  Platerus. 

The  fourth  section  is  devoted  to  the  elucida- 
tion of  what  is  conceived  to  be  a  proper  basis, 
character,  and  method  of  the  nomenclature  and 
classification  of  the  diseases  of  man :  and  to  the 
definitions  of  the  terms  of  classification. 

The  fifth  section  is  intended  as  further  explana- 
tions of  the  morbid  states  and  morbific  processes, 
and  as  an  analysis  of  some  of  the  terms  used  in 
general  pathology,  besides  which  it  embodies  a 
summary  of  the  present  state  of  knowledge  of 
the  bacteria,  ptomaines,  ieucomaines,  and  "  ex- 
tractives," and  indicates  the  relations  borne,  to 
medicine  and  surgery,  by  these  microorganisms 
and  toxic  alkaloids  of  putridity,  and  finally  re- 
marks on  the  neoplasms  and  on  their  classifica- 
tion. 

2.  This  work  is  undertaken  with  the  hope  that 
it  will  induce  all  those  devoted  laborers  in  the 
field  of  medical  science  who  are  struggling  so 
diligently  to  solve  great  problems  in  physiology, 
histology,  pathoanatomy,  and  therapy,  to  con- 
sider how  much  assistance  methodical  arrange- 
ment will  afford  them  in  their  investigations  and 
how  much  of  their  time  will  thereby  be  saved  J 


INTRODUCTION.  1 5- 

also  how  important  it  will  be  for  them  to  adopt  a 
correct  and  uniform  nomenclature.  They  will 
then  probably  reject  all  inexact  terms  and  coin 
words, — **  verba-fidelia  " — in  accordance  with  the 
conditions  they  wish  to  designate  with  precision. 

In  medicine,  the  coinage  of  a  new  word  is  at» 
tended  with  some  difficulty  and  requires  much 
deliberation,  besides  the  censorship  of  men  of  ex- 
perience and  sound  judgment.  The  word  should 
then  be  submitted  to  the  profession,  whose  ver- 
dict on  the  question  of  its  general  adoption 
should  be  respected.  On  this  subject  of  the  coin- 
age of  words,  Ben  Jonson  says  :  "  A  man  coins 
not  a  new  word  without  some  peril,  and  less 
fruit ;  for  if  it  happen  to  be  received,  the  praise 
is  but  moderate ;  if  refused  the  scorn  is  assured." 

At  present,  a  very  considerable  part  of  the 
nomenclature  of  medicine  consists  of  such  a  great 
number  of  inappropriate,  incorrectly  formed  and 
misleading  terms,  that  often  it  is  not  easy,  for 
investigators,  even  of  the  same  nation,  writing  in 
the  same  tongue,  to  understand  each  other. 

"  It  is  a  waste  of  time,"  says  Mill,  in  his  Exam- 
ifzation  of  Sir  William  Hamilton  s  Philosophy,  "  for 
a  mere  student  of  philosophy  to  have  to  learn 
the  familiar  use  of  fifty  philosophic  phrase- 
ologies." This  applies  with  much  force  to  the 
many  anatomists  and  medical  investigators  who 


l6  INTRODUCTION. 

use  words  of  their  own  invention  which  others 
are  at  great  pains  to  understand. 

3.  While  the  progress  made  in  medical  art 
during  the  last  quarter  of  a  century  is  marvelous, 
the  improvement  in  the  nomenclature  has  by  no 
means  kept  pace  with  this  great  advance  in  the 
art  of  medicine.  Accuracy  is  often  attained  in  the 
latter  while  it  seldom  obtains  in  the  former.  If 
more  attention  were  given  to  the  formation  of 
scientific  language,  much  confusion  and  misap- 
prehension, which  have  the  effect  to  impede  the 
progress  of  medical  science,  would  be  avoided. 

The  technical  terms  of  medicine  derived  from 
the  Latin  and  Greek  tongues  are  used  partly  for 
the  sake  of  brevity  and  partly  that  they  may  be 
understood  by  the  medical  profession  of  the  dif- 
ferent nations  that  cultivate  the  dead  languages. 
Unfortunately  hovvever  the  cultivation  of  these 
languages  is  too  limited  among  physicians.  As  a 
consequence,  many  meaningless  expressions  and 
as  many  hybrid  words,  compounded  of  Latin  and 
Greek  and  sometimes  of  Hebrew  roots,  very  dis- 
tasteful to  the  experienced  scholar  and  serving  to 
puzzle  rather  than  to  instruct  the  junior  student, 
are  constantly  used  in  text-books  and  other 
works.  The  few  modern  writers  who  have  un- 
dertaken the  task  of  improving  the  nomenclature 


INTRODUCTION.  1 7 

of  medicine  are  little  heeded,  and  professors  in 
the  great  schools  are  still  thoughtlessly  dissem- 
inating false  notions  by  the  careless  use  of  inac- 
curate expressions  in  their  daily  lectures.  Many 
ancient  words,  however  inexact  and  absurd,  are 
adhered  to  with  great  tenacity,  and  innovations 
the  most  appropriate  are  resisted  with  an  ob- 
stinacy too  little  in  keeping  with  the  forward 
movement  of  the  time.  Conservatism  is  praise- 
worthy Avhen  applied  to  words  that  have  stood 
the  test  of  years  and  are  still  adjudged  good  and 
proper,  Those  time-honored  terms  v/hich  convey 
ideas  with  precision  should  be  jealously  pre- 
served ;  but  that  multitude  of  misleading  expres- 
sions, to  be  found  in  the  literature  of  medicine, 
should  be  speedily  blotted  out  of  coming  medical 
treatises  and  dictionaries,  and  their  places  filled 
with  well  chosen  and  philologically  correct 
words. 

If  teachers  in  the  several  departments  of  medi- 
cine will  earnestly  consider  this  subject,  and  if 
each  will  contribute  his  share  to  the  reformation, 
in  another  quarter  of  a  century  there  will  surely 
be  a  more  uniform  and   exact  medical  language. 

The  needed  reformation  in  medical  nomencla- 
ture should  however  be  rightly  directed,  and 
those  who  undertake  it  should  be  mindful  of 
Lord  Bacon's  precept  that  "  It  is  good  also,  not 


I8  INTRODUCTION. 

to  try  experiments ;  except  the  necessity 

be  urgent,  or  the  utility  evident :  and  well  to 
beware  that  it  be  the  reformation  that  draweth 
on  the  change ;  and  not  the  desire  of  change 
that  pretendeth  the  reformation." 

4.  It  is  improbable  that  the  often  repeated 
statement,  "  it  is  not  profitable  to  attempt  to 
change  the  present  methods  of  writing  and  of 
teaching  medicine  owing  to  its  great  mutability,*^ 
will  deter  nomenclators  and  classifiers  from  the 
pursuance  of  their  investigations,  but  it  is  a  fact 
that  they  are  too  little  encouraged,  even  by  those 
who  realise  the  necessity  of  a  radical  change  in 
these  methods.  Exact  nosonomy  and  nosotaxy 
will  surely  cause  greater  changes  and  advances 
than  have  ever  been  made  in  medicine.  To  give 
correct  names  to  diseases  involves  the  closest  in- 
quiry into  their  nature.  It  is  therefore  fair  to 
assume  that  the  time  will  come  when  the  name 
given  to  each  disease  shall  indicate  its  nature. 
When  this  good  time  does  come,  medicine  will 
be  taught  as  other  sciences  are  taught.  The  con- 
sideration of  the  advances  destined  to  be  made 
by  a  methodical  nosography,  leads  to  the  conclu- 
sion that  it  must  keep  pace  with  the  advancement 
to  which  it  has  given  rise,  and  must  of  necessity 
be  provisional. 


INTRODUCTION.  1 9 

5.  The  inexact  nomenclature  of  diseases,  and 
the  defective  arrangement  and  inconsistencies  in 
existing  S3'stems  are  such  that  it  is  almost  im^ 
possible  for  the  student  to  learn  medicine  as  he 
should ;  and,  in  view  of  its  continued  advances, 
this  will  be  quite  impossible  in  a  quarter  of  a 
century,  unless  a  radical  change  be  made  first  in 
the  nomenclature  of  anatomy  and  next  in  the 
nomenclature  and  classification  of  diseases. 

Without  an  accurate  nomenclature  and  classi- 
fication, the  one  hundred  and  tvv^enty  thousand 
flowering  plants  could  not  have  been  known,  nor 
could  the  immense  number  of  species  of  animals 
be  studied,  and  it  would  not  have  been  possible 
to  obtain  an  accurate  knowledge  of  minerals. 
Thus  Botany,  Zoology,  and  Mineralogy,  have  for 
many  years,  taken  each  a  high  rank  among  the 
sciences  owing  to  proper  nomenclature  and  to 
methodical  arrangement. 

The  science  of  medicine  will  never  progress  as 
it  should  and  will  never  be  learned  as  it  should 
be  learned  until  it  is  placed  upon  the  same  foot- 
ing as  that  of  the  natural  sciences. 

Without  an  accurate  nomenclature  and  classi- 
fication it  is  very  difficult  for  the  practising  phy- 
sician to  have  the  clear  understandmg  of  diseases 
so  necessary  to  their  rational  treatment.  All 
morbid    states   of    the   human   body   should   be 


20  INTRODUCTION. 

known  by  names  that  indicate  their  nature,  and 
it  is  only  a  right  conception  of  this  nature  which 
can  lead  to  the  use  of  appropriate  remedies. 

6.  The  terras  nomenclature  and  classiiication  of 
diseases  do  not  by  themselves  express  with  suf- 
ficient precision  the  scope  and  objects  of  syste- 
matic arrangement.  Therefore  the  word  nosog- 
raphy  should,  in  its  broadest  sense,  be  employed 
to  signify  the  whole,  or  some  part  of  the  science 
of  medicine  as,  for  example,  human  nosography, 
nosography  of  the  uro-genital  apparatus,  or  of 
any  other  apparatus  of  the  human  body. 

7.  It  is  often  said  that  language  fails  to  express 
with  accuracy  the  ideas  which  man  conceives  of 
things.  Sweepmg  as  this  statement  may  seem,  it 
is  defensible,  particularly  in  the  case  of  medical 
language  which  so  much  needs  reconstruction. 
That  however  which  causes  the  greatest  per- 
plexity in  the  expression  of  ideas,  is  the  misap- 
plication of  words,  and  also  their  employment  in 
different  senses,  so  as  to  give  to  each  several 
meanings.  Since  it  is  not  probable — at  least  not 
for  a  very  long  time — ,  that  human  language  will 
consist  of  words  having  each  a  single  meaning, 
the  most  judicious  use  should  be  made  of  existing 
terms  and  the  greatest  care  taken  in  the  forma- 
tion of  new  words ;  and  all  writers  should  strive 


INTRODUCTION.  21 

to  give  a  clear  exposition  of  their  ideas  by  some- 
times explaining  the  words  of  many  meanings 
which  they  are  obliged  to  employ.  Some  of  the 
great  faults  in  medical  language  are :  (i,)  the 
misapplication  of  words;  (2,)  the  use  of  improp- 
erly  constructed  words;  (3,)  the  use  of  words 
which  do  not  convey  an  exact  idea  of  the  object 
designated  ;  and  (4,)  the  use  of  men's  names  to 
designate  diseases.  These  faults  are  all  remedia- 
ble, but  to  repair  them  most  effectually  and  to 
prevent  their  recurrence,  a  consense  of  views  in 
the  medical  profession  is  absolutely  necessary ; 
then  the  changes  in  terms  will  be  uniform,  will 
come  authoritatively,  and  will  therefore  be  ac- 
cepted. 

It  appears  that  medicine  is  not  the  only  science 
whose  progress  has  been  hindered  by  abuses  in 
terms. 

In  his  Elements  of  the  Philosophy  of  the  Human 
Mind,  Dugald  Stewart  says  :  "  When  I  consult 
Johnson's  Dictionary,  I  find  many  words  of  which 
he  has  enumerated  forty,  fifty,  or  even  sixty  dif- 
ferent significations  ;  and,  after  all  the  pains  he 
has  taken  to  distinguish  these  from  each  other,  I 
am  frequently  at  a  loss  how  to  avail  myself  of  his 
definitions." 

A  great  thinker  and  metaphysician  comments^ 


22  INTRODUCTION. 

-as  follows,  upon  words  and  deplores  their  wrong 
usage. 

" In  words  are  contained  the  knowledge 

and   sciences   possessed    by  the   nations   of    the 

earth A  strict  adherence  to  propriety  in 

the  use  of  words,  is  the  only  means  for  maintain- 
ing clearness  of  ideas,  for  preserving  and  har- 
monising them Many  ancient  and  modern 

sophists,  and  many  profane  philosophers,  sought 
artfully  to  alter  the  true  value  and  force  of 
words.  The  world  could  scarcely  be  deceived 
except  by  such  alteration.  Abuse  has  been  made 
of  almost  all  philosophical  and  political  terms,  as 
has  been  frequently  shown  by  various  writers. 
Whoever  takes  note  of  the  errors  that  have  arisen 
from  the  abuse  of  the  word  Nature,  in  the 
sciences  of  Right  and  Politics — of  the  words 
Sensation,  Pleasure,  Pain,  in  Metaphysics  ;  of  the 
words  Equality  and  Liberty  in  Politics;  of  the 
word  Wealth  in  Political  Economy — and  of  the 
many  others  to  which,  generally,  there  has  been 
added  only  a  more  extensive  signification  than 
that  given  them  by  common  usage,  will  discover 
the  sources  of  incredible  deceptions  to  the  mind, 
and  of  incredible  evils  to  humanity."  (Rosmini^ 
Introduzione  alia  Filosojia.) 

Max  Miiller  in  his  Science  of  Thought ^  1887,  (p. 
18)  says  :,.....*'  That  every  one  of  these  words 


INTRODUCTION.  23 

is  used  in  different  senses  by  different  philoso- 
phers, might  be  tolerated,  if  each  philosopher 
would  tell  us  clearly,  and  once  for  all,  in  what 
sense  he  himself  means  to  use  them.  This  is 
what  few  attempt  to  do ;  and  if  they  do  it,  they 
often  seem  to  imagine  that  because  there  are  so 
many  words,  there  must  be  also  so  many  distmc- 
tions.  They  overburden  us  with  definitions  and 
make  confusion  worse  confounded." 

The  following,  which  is  much  to  the  purpose 
is  also  quoted  from  the  recent  work  of  Max 
Miiller. 

"  All  I  maintain  is  that,  not  only  to  a  considera- 
ble extent,  but  always  and  altogether,  we  think 
by  means  of  names,  and  that  things  are  no  more 
to  us  than  what  we  mean  by  their  names.  What 
we  really  mean  by  names  must  be  settled  by  defi- 
nition, and  according  as  our  knowledge  changes, 
the  definition  and  therefore  the  meaning  of  names 
will  change.  Every  new  addition  to  our  ex- 
perience may  be  said  to  change,  to  correct,  or  to 
complete  the  intension  and  the  extension  of  our 
names,  but  before  we  can  use  our  new  knowledge, 
it  must  always  have  been  embodied  either  in  an 

old  or  a  new  name There  may  be  little  or 

much,  there  may  be  false  or  true  knowledge  in 
our  names,  but  without  some  sort  of  name  we 
cannot  reason,"  (p.  35,  Science  of  Thought,) 


24  INTRODUCTION. 

8.  As  a  means  to  the  desired  end,  students  of 
medicine  should  be  thoroughly  drilled  in  the  use 
of  words  of  precision,  whose  employment  is 
coupled  with  exact  knowledge, — not  forgetting 
the  fact  that  to  name  is  to  know^  for  these  two 
words  have  been  traced  to  the  same  root  whose 
antiquity  is  almost  as  great  as  that  of  man — ,  and 
exact  medical  knowledge,  methodically  arranged, 
will  inevitably  lead  to  its  practical  application  in 
the  cure  of  disease  or  the  alleviation  of  human 
suffering.  High  as  is  the  achievement  of  curing 
disease  or  of  alleviating  suffering,  the  physician 
should  aspire  to  the  still  higher  object  of  preserv- 
ing the  health  of  the  people.  This  should  be  the 
end  of  medicine. 


•^ 


PRINCIPLES 

OF 

NOMEiXCLATURE  AND  CLASSIFICATION. 


SECTION  I. 

Preliminary  Considerations. 

Outline  of  the  anatomical  view  of  man.  Definition  of  medi- 
cine. A  classification  of  the  science  and  art  of  medicine. 
Medicine  and  Surgery.  Arrangement  of  medicine  into  certain 
departments  in  accordance  with  the  apparatuses  of  the  human 
body.  The  physician.  Definition  of  disease.  A  synopsis  of 
the  morbid  states  and  morbific  processes  of  the  body.  The 
value  and  significance  of  proper  anatomical  terms  in  classifi- 
cation. Definition  of  system,  organ,  apparatus,  and  function. 
Systems  and  organs  perform  no  function,  but  yield  service  to 
apparatuses.  Each  apparatus  performs  only  one  function, 
and  there  is  no  function  without  an  apparatus. 

THE   HUMAN   BODY. 

Anatomically  considered  man's  body  is  a 
grand  complex  apparatus  destined  to  perform 
the  one  function  of  reproduction  of  its  species. 
To  that  end  the  male  and  female  must  couple. 
The  sperm  of  the  male  then  fecundates  the  ovum 


26  THE    HUMAN   BODY. 

which  is  within  the  female,  and  she  completes 
the  function  of  reproduction  of  the  species. 

This  primary  human  apparatus  is  an  assem- 
blage of  secondary  apparatuses  that  are  intended 
to  perform  certain  special  functions,  some  of 
which  are  designed  to  conserve  the  individual, 
and  others  to  keep  the  body  in  a  healthy  condi- 
tion and  fit  it  for  the  performance  of  its  one  great 
function. 

The  senses  of  man,  each  of  which  being  the 
function  of  a  special  apparatus,  are  all  subservi- 
ent to  the  genetic  sense,  to  the  one  paramount 
function,  requiring  the  union  of  the  sexes  for  its 
accomplishment. 

Such  are  the  facts  that  may  be  gleaned  from 
anatomy,  but  archaeology  too  teaches  its  lesson. 
It  appears  that  many  of  the  ancient  nations  made 
the  external  genital  organs  of  both  sexes  objects 
of  worship,  so  much  importance  did  they  attach 
to  generation,  and  that  traces  of  phallic  worship 
have  been  discovered  within  a  comparatively  re- 
cent period,  even  among  the  savage  tribes  of  the 
South  Sea  Islands,  and  of  North,  Central,  and 
South  America. 

Anatomy  and  archaeology  having  spoken  their 
word,  if  a  glance  be  now  cast  at  chapter  i,  verse 
28,  of  the  Book  of  Genesis,  it  will  be  seen  that, 
for  a  long  series  of   centuries,    civilized  man  has 


THE   HUMAN   BODY.  2/ 

entertained  the  belief  that  the  object  of  his  exist- 
ence is  to  multiply  his  species.  The  first  com- 
mand to  man  was  "  Increase  and  multiply  and 
fill  the  earth."  That  was  to  be  the  one  function 
of  man.  The  other  commands,  to  subdue  the 
earth  and  rule  over  all  living  creatures,  are  sub- 
ordinate to  the  first  command,  to  the  one  func- 
tion. Man  was  to  subdue  the  earth  to  the  end 
of  fulfilling  that  first  command,  and  he  was  to 
rule  over  all  living  creatures  and  make  such  use 
of  them  as  might  be  subservient  to  that  first 
command.  The  general  disobedience  of  that 
command  w^ould  entail  disease,  death  and  the 
speedy  extinction  of  the  species. 

All  organic  nature  is  busy  with  the  multiplica- 
tion of  species.  In  the  lowest  forms  of  animal 
and  vegetable  life  this  multiplication  continues 
until  by  some  accident  the  process  is  interrupted. 
Such  an  interruption  is  one  of  the  checks  to  the 
inordinate  increase  of  the  species ;  but  when  the 
process  ceases,  extinction  is  the  inevitable  out- 
come. 

Man  alone  is  prone  to  violate  the  great  law  of 
creation  which  impels  organized  beings  to  repro- 
duce their  kind.  In  these  days  there  are  too 
many  unfortunates  who,  desirous  to  sin  without 
conceiving,  adopt  the  most  injurious  means  to 
effect  their  purpose.     Among  these  may  be  men- 


28      DEFINITION   AND    OBJECTS    OF   MEDICINE. 

tioned  the  iniquity  of  Onan,  so  common  among 
the  hig-her  classes,  so  demoralising  and  so  hurt- 
ful to  both  the  male  and  female. 

Most  persons  are  conscious  that  many  of  their 
diseases  are  caused  by  their  own  vices  and  ex- 
cesses, the  consequences  of  which  are  certain  to 
assail  and  perhaps  to  destroy  them.  Often 
blinded  however  by  their  passions,  or  heedless  of 
nature's  inexorable  laws  they  fail  to  perceive  the 
cause  of  a  particular  malady  until  it  is  almost  if 
not  altogether  too  late  for  its  removal.  Then 
perhaps  they  have  reluctant  recourse  to  the 
physician. 

DEFINITION   AND    OBJECTS   OF   MEDICINE. 

It  often  happens  that  certain  patients  long 
hesitate  to  consult  the  true  physician,  who  pre- 
scribes for  disease  and  not  for  symptoms,  be- 
cause of  their  vague  notions  of  the  character  and 
scope  of  rational  medicine — so  much  derided  by 
cynics  and  charlatans — and  of  their  idea  that  the 
practiser  of  medicine  gropes  in  the  dark  in  his 
search  for  the  nature  of  diseases  and  for  the 
means  of  their  cure,  and  that  his  diagnosis  is  con- 
jectural while  his  treatment  is  empirical.  To  a 
man  of  this  class  the  title  of  Doctor  in  medicine 
is  a  misnomer,  because  the  "  Doctors  "  whom  he 


DEFINITION   AND    OBJECTS   OF   MEDICINE.      29 

knows  are  neither  learned  nor  wise.  He  had 
never  been  able  to  make  the  distinction  between 
the  ignorant  pretender  and  the  conscientious  and 
well  qualified  physician.  He  is  at  length  brought 
face  to  face  with  a  Doctor  whose  mental  quali- 
ties give  him  a  right  to  the  title.  After  a  short 
conference  he  propounds  the  old  question  so 
often  asked  by  the  laity,  ''  what  is  meant  by 
medicine,  and  can  it  be  ranked  as  a  science  "  ? 
The  answer  to  this  question  involves  a  definition 
of  a  science  and  of  an  art.  If  knowledge, 
acquired  by  study,  experiment,  and  observation, 
methodically  arranged  to  serve  as  a  basis  upon 
which  are  established  general  and  particular 
principles  for  guidance  in  the  practice  of  an  art, 
be  accepted  as  one  of  the  definitions  of  a  science, 
and  if  an  art  can  be  defined  as  skill  acquired  in 
the  use  of  means  for  the  accomplishment  of  an 
end,  then  medicine  is  entitled  to  be  ranked  as  a 
science  and  an  art.  These  definitions  mav  be 
thus  condensed  ;  science  is  to  know,  and  art  is  to 
do.  This  is  the  answer  to  the  second  part  of  the 
question.  The  first  part  will  be  answered  by  a 
definition  of  medicine  and  by  a  concise  statement 
of  its  aims  and  of  the  methods  employed  in  its 
study. 

Medicine,*  as  related  to  man,  may  be  defined 

*  Medicine,  from  mederi,  to  heal. 


30      DEFINITION   AND    OBJECTS   OF   MEDICINE. 

as  the  science  of  man  in  his  abnormal  states,  and 
the  art  of  curing  or  ol  alleviating  disease. 

Medicine  presupposes  the  science  of  man  in 
his  normal  state,  and  implies  the  arts  of  preserv- 
ing health,  of  preventing  disease,  and  of  prolong- 
ing life. 

Medicine    and     its   fundamental    science    and 
associated    arts  lay  under   contribution   botany, 
zoology,  mineralogy,  chemistry,    pharmacology, 
physics,  mathematics,    and  mechanics  ;    assist  in 
the  execution  of  the  law  of  the  land,  particularly 
in    the   special    department   known   as    Medical 
Jurisprudence  ;  aid  the  State  in  the  prevention 
of    disease,    through   the    department   of    State 
Medicine ;    and    have   their   influence   upon   the 
morals   of  the    people.     The  system  of   medical 
morals  written   by  the  Father  of  scientific  medi- 
cine more   than  two   thousand  years   ago,  is  so 
sound  in  its  broad  principles  as  to  have  required 
no  changes  except  in  a  few  details,   and  the  addi- 
tions that  have  been  made  thereto  only  serve  to 
enforce  these  principles.    The  best  modern  ethical 
essays  are  founded    upon   the  Hippocratic  oath 
which  was  itself  erected  upon  the  imperishable 
foundation    of  reason,   truth,   justice,   and    bene- 
ficence.    There  can   be    only   one  medicine,  the 
medicine  which,  together  with  its  fundamental 
science   and  associated  arts,  is  ever  seeking  the 


CLASSIFICATION    OF   MEDICINE.  3 1 

truth,  and  whose  objects  are  to  prevent,  heal,  or 
alleviate  disease,  to  preserve  health,  and  to  pro- 
long life. 

True  medicine,  founded  as  it  is  upon  biology, 
is  not  fettered  by  dogmata  and  is  therefore  al- 
ways advancing.  The  student  of  medicine  must 
understand  the  laws  of  life,  and  be  acquainted 
with  the  science  of  man  in  his  normal  condition, 
and  very  particularly  with  the  functions  of  the 
apparatuses  of  his  body.  Until  then  he  is  unfit 
to  study,  and  still  more  unfit  to  cope  with  dis- 
ease. This  leads  to  what  is  believed  to  be  a 
proper  classification  of  medicine. 

CLASSIFICATION   OF   MEDICINE. 

Medicine  comprises :  (A,)  the  science ;  and 
(B,)  the  art  of  medicine. 

A.  THE  SCIENCE  of  medicine  and  its  funda- 
mental science  of  man  in  a  normal  state  consist : 
(I,)  of  anthropophysiography,  or  the  description 
of  man  in  a  state  of  health  ;  and  (II,)  of  anthro- 
ponosography,  or  the  description  of  man  in  a 
state  of  disease. 

I.  Anthropophysiography  comprises  all  the 
branches  of  anatomy  and  is  the  same  as  human 
biology. 

Anatomy  is  divided  into:     (i,)  transcendental 


32  CLASSIFICATION   OF   MEDICINE. 

anatomy  ;  (2,)  homological  anatomy ;  (3,)  phys- 
iognomical anatomy;  (4,)  embryology;  (5,)  de- 
scriptive anatomy  ;  (6,)  comparative  anatomy ; 
(7,)  topographical  anatomy ;  (8,)  histology ;  (9,) 
stoechiology  ;  (10,)  human  ph^^siology  ;  and  (11,) 
comparative  physiology.* 

1.  Transcendental  anatomy  is  the  study:  (i,)  of 
the  general  design  of  the  body  ;  and  (2,)  of  the 
particular  design  of  the  organs. 

2.  Homological  anatomy  is  the  study  of  the  cor- 
relations of  the  several  parts  of  the  body — (i,)  of 
the  organs  and  their  parts  ;  (2,)  of  the  tissues ; 
and  (3,)  of  the  apparatuses  of  the  body. 

J.  Physiogjtomical  anatomy  is  the  study  of  ex- 
pressions depicted  upon  the  exterior  of  the  body, 
more  particularly  upon  the  face,  such  as  expres- 
sions of  joy,  despondency,  mental  anxiety,  pain, 
fear,  anger,  etc. ;  and  is  also  the  study  of  those 
expressions  induced  by  disease. -f 


*  These  branches  of  anatomy  are  not  ordinarily  studied  in 
the  order  in  which  they  appear  above,  but  the  arrangement 
adopted  is  in  correspondence  with  the  general  plan  of  this 
work. 

t  The  facies  of  disease  were  very  long  ago  carefully  studied. 
Hippocrates  described  so  graphically  the  expression  often  in- 
duced by  the  exhaustion  incidental  to  certain  chronic  and 
acute  diseases,  and  by  long  fasting,  that  this  expression  bears 


CLASSIFICATION   OF   MEDICINE.  33 

^.  Embryology  is  the  study  :  (i,)  o^  the  fecund- 
ation of  the  ovum  ;  (2,)  of  the  growth  of  the 
embryo ;  and  (3,)  of  the  development  of  the 
organs. 

5.  Descriptive  anatomy  is  the  study  :  (i,)  of  the 
general  configuration  of  the  body  and  of  the 
particular  configuration  of  its  several  parts  ;  (2,) 
of  the  gross  appearances  of  the  organs  ;  (3.)  of 
the  construction  of  the  organs  ;  (4,)  of  the  form, 
size,  color,  consistency  and  weight  of  the  organs ; 
and  (5,)  of  the  composition  of  the  apparatuses. 

6.  Comparative  anatomy  is  the  study  and  com- 
parison of  the  body  and  organs  of  man  with 
those  of  the  lower  animals.  Its  object  is  to  ascer- 
tain the  nature  of  the  modifications  of  structure 
adapted  to  the  needs  of  different  animals. 

7.  Topographical  anatomy  is  the  study  of  the 
situations  and  relations  of  the  several  parts  and 
organs  of  the  body. 

8.  Histology  is  the  study:  (i,)  of  the  minute 
structure  of  the  tissues  ;  and  (2,)  of  the  minute 
structure  of  the  organs. 


the  name  of  fades  Hippocratica,  There  are  too  the  facies  of 
cancer,  of  tuberculosis,  of  cholera,  of  hysteria,  of  epilepsy,  etc. 
The  facial  expressions  varying  also  according  to  the  seat  of 
particular  diseases. 


34  CLASSIFICATION   OF   MEDICINE. 

9.  Stoechiology  *  is  the  study  of  the  chemical 
elements  of  the  gases,  fluids,  and  solids  of  the 
body. 

10.  Htwian physiology  is>  t\iQ  studiy '.  (i,)  of  the 
uses  of  the  organs  ;  and  (2,)  of  the  functions  of 
the  apparatuses  of  the  body  of  man. 

//.  Comparative  physiology  is  the  study  and 
comparison  of  the  uses  of  the  organs  and  of  the 
functions  of  the  apparatuses  of  all  organized 
beings. 

11.  Antroponosography,  which  should  be 
based  upon  all  the  branches  of  anatomy,  consists 
of  the  two  divisions:  (i,)  teratology;  and  (2,) 
pathology. 

1.  Teratology  is  the  study  of  the  congenital 
anomalies  of  the  whole  or  of  parts  of  the  body. 

2.  Pathology  is  the  study:  (i,)  of  general 
diseases ;  (2,)  of  diseases  of  particular  organs ; 
{3,)  of  diseases  consequent  upon  parasitic  inva- 
sion of  the  human  organism  ;  (4,)  of  the  conse- 
quences of  the  introduction  of  foreign  substances 
into  the  body ;  (5,)  of  the  effects  of  injuries  ;  (6,) 
of  the  consequences  of  the  ingestion  of  poisons  ; 
and  (7,)  of  functional  disorders  of  the  appara- 
tuses. 

*  Stoechiology — from  6roix^iov,  an  element — is  ordinarily 
taught  under  the  names  of  physiological  chemistry  and  organic 
chemistry. 


CLASSIFICATION   OF   MEDICINE.  35 

The  means  employed  in  the  study  of  disease 
consist  in  making  proper  use  ;  (i,)  of  aetiology  ; 
(2,)  of  symptomatology  ;  (3,)  of  semeiology  ;  (4,) 
of  pathoanatomy  ;  (5,)  of  pathohistology ;  (6,)  of 
nosonomy ;  (7,)  of  nosotaxy  ;  (8,)  of  diagnosis  ; 
and  (9,)  of  prognosis. 

B.  THE  ART  of  medicine  and  its  associated 
arts  consist:  (i,)  of  h3^giene,  or  the  art  of  pre- 
serving health  ;  (2,)  of  prophylaxy,  or  the  art  of 
preventing  disease  ;  (3,)  of  therapy,  or  the  art  of 
curing  or  of  alleviating  disease ;  and  (4,)  of 
biothalmy,  or  the  art  of  prolonging  life. 

I.  Hygiene,*  or  the  art  of  preserving  health — 
The  preservation  of  health  is  generally  effected 
by  the  strict  observance  of  the  rules  which  relate 
to  the  maintenance,  in  their  normal  state,  of  the 
functions  of  the  body  and  which  are  directed 
principally:  (i,)  to  alimentation;  (2,)  to  exer- 
cise; (3,)  to  clothing;  (4,)  to  sleep  ;  (5,)  to  ablu- 
tion ;  (6,)  to  residence  ;  (7,)  to  ventilation  ;  (8,) 
to  light ;  (9,)  to  temperature  ;   etc. 

II.  PROPHYLAXY,t  or  the  art  of  preventing  dis- 
ease.— Disease  may  be  prevented  :  (i,)  by  avoid- 
ance of  contagion ;  (2,)  by  abstention  from  ex- 
cesses ;  (3,)  by  the  strict  observance  of  the  rules 

*  Hygiene,  from  vyi'sid,  health. 

t  Prophylaxy,  from  itpo,  beforehand,  and  (pvXdzr eiv y  to 
guard. 


36  CLASSIFICATION    OF   MEDICINE. 

of  hygiene ;  (4,)  by  the  use  of  medicinal  sub- 
stances having  propy lactic  properties  ;  (5,)  by 
the  selection  of  a  suitable  climate  ;  (6,)  by  disin- 
fection ;  (7,)  by  proper  house  drainage  ;  (8,)  by 
the  isolation  of  cases  of  contagions  disease. 

III.  Therapy,  *  or  the  art  of  curing  or  of  al- 
leviating disease. — It  should  be  borne  in  mind 
that  many  diseases  are  cured  by  unassisted  na- 
ture, nevertheless  they  require  the  closest  ob- 
servation of  the  medical  attendant.  Meddle- 
some physic  in  such  circumstances  is  often  pro- 
ductive of  much  evil.  Here  then  is  a  field  for 
the  exercise  of  good  judgment  on  the  part  of  the 
wise  physician  who  knows  when  to  apply  and 
when  to  abstain  from  applying  remedies.  Here 
too  is  the  opportunity  for  the  charlatan  to  make 
the  most  of  his  spurious  wares,  and  to  boast  of 
*'  great  cures  "  which  he  never  effected.  How- 
ever, in  ordinary  circumstances  of  disease,  na- 
ture needs  assistance  and  this  assistance  should 
be  intelligent,  prompt,  and  efhcient.  Such  assist- 
ance may  be  directed  :  (i,)  to  a  general  disease ; 
(2,)  to  a  special  disease  of  a  particular  organ  ; 
(3,)  to  an  injury ;  etc.  The  internal  use  of  med- 
icaments, external  applications,  mechanical  ap- 
pliances, or  the   surgeon's   ministrations,  may  be 


*  Therapy,  from  OspaTCevsiVy  to  cure. 


CLASSIFICATION   OF   MEDICINE.  3/ 

needed.  From  these  resources,  for  the  cure  or 
alleviation  of  disease,  it  is  the  office  of  the 
physician  to  select  that  which  is  suited  to  in- 
dividual cases. 

IV.  BiOTHALMY,*  or  the  art  of  prolonging  life. 
— Man's  life  may  be  prolonged  beyond  its  ordi- 
nary duration,  if  he  be  free  from  disease,  (i,)  by 
great  sobriety  and  moderation  in  all  his  acts  ;  (2,) 
by  the  close  observance  of  the  rules  of  hygiene ; 
(3,)  by  avoidance  of  exposure  during  inclement 
weather ;  and  (4,)  by  his  leading  a  serene  exist- 
ence, free  from  the  cares  of  ordinary  life,  but 
with  pleasant  pursuits. f  When  man  is  affected 
with  incurable  disease,  his  life  may  be  prolonged : 


*  Biothalmy,  from  Bio^aXjuioi,  long-lived.  Macrobiosis 
is  also  used  to  express  the  idea  of  longevity. 

t  On  this  important  subject  of  the  prolongation  of  man's 
life,  the  reader  may,  u'ith  advantage,  consult  "  The  Code  of 
Health  and  Longevity,"  by  Sir  John  Sinclair,  Edinburgh,  1807. 
This  very  interesting  and  valuable  compilation,  in  four  octavo 
volumes,  contains  :  rules  for  preserving  health  and  promoting 
longevity ;  regulations  for  the  health  of  the  community  ;  an 
account  of  the  doctrines  of  Hippocrates  concerning  health  and 
longevity ;  also  accounts  of  Galen ;  of  the  minor  Greek 
authors ;  and  of  the  Arabian  and  Jewish  authors  who  have 
written  on  the  subject  of  health  ;  and  of  Cicero  and  Seneca 
on  old  age  and  the  shortness  of  life.  It  also  contains  the 
"Regimen  Sanitatis  Salerni,"  with  Doctor  Holland's  transla- 
tion thereof ;  an  account  of  Lewis  Cornaro,  a  Venitian  gentle- 


38  CLASSIFICATION   OF   MEDICINE. 

(i,)  by  a  proper  dietary  ;  (2,)  by  suitable  medica- 
ments ;  (3,)  by  the  maintenance  of  certain  func- 
tions, as  far  as  practicable,  in  their  normal  state  ; 
(4,)  by  rest  or  exercise  as  needed,  and  attention  ta 
the  conditions  of  the  physical  surroundings  ;  (5,} 
by  mechanical  appliances ;  and  (6,)  by  a  surgical 
operation,  if  such  be  required. 

man  who  livecl  a  "  sober  life  "  and  died  aged  upward  of  one 
hundred  years ,  of  the  weighing  chair  of  Sanctorius  and  of  his 
Medicina  Statica ;  and  an  account  of  British  authors  wha 
have  written  upon  health  and  longevity,  from  Friar  Bacon, 
vrho  died  in  the  year  1292,  to  Doctor  Waterhouse  in  1805. 
Among  the  many  accounts  of  centenarians  given  in  this  work,, 
are  those  of  John  Rovin  in  his  one  hundred  and  seventy- 
second  (172)  year,  and  of  his  wife  Sarah  in  her  one  hundred 
and  sixty-fourth  (164)  year,  and  of  Petratsch  Zortan  in  the 
one  hundred  and  eighty-fifth  (185)  year  of  his  age,  with  en- 
gravings of  their  portraits  which  had  belonged  to  the  Percys^ 
Earl  of  Northumberland. 

An  essay  by  J.  P.  M.  Flourens,  bearing  the  following  title, 
may  also  be  profitably  consulted  :  "  De  la  longevite  humaine 
et  de  la  quantite  de  vie  sur  le globe,"     Paris,  1856. 

A  very  interesting  paper  on  "  the  habits  and  family  history 
of  centenarians"  by  Professor  Humphry  appeared  in  the 
"  Popular  Science  Monthly  "  for  March  1887.  This  paper  had 
formed  a  part  of  a  report  on  the  subject  by  Professor  Hum- 
phry to  the  British  Medical  Association.  It  contains  an 
analysis  of  the  table  of  centenarians,  by  A.  Francis,  M.  R, 
C.  S.,  of  Kings  College,  Cambridge,  which  is  well  worthy  of 
careful  perusal. 


39 

MEDICINE  AND   SURGERY. 

Medicine  has  been  separated  into  two  depart- 
ments :  ( I,)  Medicine  proper,  or,  as  the  French 
still  call  it,  internal  pathology  ;  and  (2,)  Surgery,, 
or  external  pathology."^     Neither  designation  is 


*  For  many  centuries  medicine  was  in  the  hands  of  the 
priesthood.  In  Eg>'pt,  for  instance,  none  but  the  priests  were 
permitted  to  minister  to  the  sick;  among  the  early  Israelites, 
the  Prophets,  Priests  and  Levites  were  the  only  physicians  ; 
and  the  Priests  of  Apollo  and  of  Esculapius  were,  for  a  long 
time,  the  only  medical  advisers  of  the  Greek  people.  This 
most  ancient  custom,  of  combining  the  offices  of  physician 
and  priest,  was  adopted  by  the  Christian  clergy  and  prevailed^ 
with  few  interruptions,  until  the  middle  of  the  eighteenth 
century. 

The  school  of  Salernum  owed  its  celebrity,  from  the  eighth 
to  the  twelveth  century,  to  the  many  learned  members  of  the 
clergy  who  there  taught  or  were  taught  medicine.  Among 
these  illustrious  men  may  be  mentioned ;  Theodore,  Arch- 
bishop of  Canterbury ;  Wigart,  Bishop  of  Hildesheim ; 
Cuthbert,  the  English  monk ;  the  monk  Campo  ;  Hughes, 
Abbot  of  Saint  Denis  ;  John  of  Ravenna  ;  and  Gerbert,  after- 
wards Pope  Sylvester  11.  They  had  all  learned  the  medicine 
of  the  Arabs. 

During  the  eleventh  century  the  Benedictine  monks  of 
Monte  Cassino  greatly  distinguished  themselves  at  the  Saler- 
num school,  and  Didier,  the  Abbot  of  Monte  Cassino,  who  be- 
came Pope  Victor  III,  was  one  of  the  teachers  in  that 
renowned  school. 

In  the  twelveth  century  priests  were  forbidden  to  practise 


40  MEDICINE  AND    SURGERY. 

rational,  for  ''  medicine  proper  "  has  to  deal  as 
much  with  external  as  with  internal  diseases,  and 
surgery  has  as  much  to  do  with  internal  as  with 
external  diseases.  The  physician  uses  his  hands 
in  diagnosis  and  in  mmistering  to  the  sufferings 
of  his  patients  as  much  as  does  the  surgeon.  The 
word  "surgery,"  meaning  simply  the  art  of 
healing  by  the  use  of  the  hands,  does  not  neces- 
sarily imply  how  the  hands  shall  be  used.  It 
does  not  mean  that  the  hand  must  needs  contain 
a  cautery  or  a  knife  any  more  than  a  blister  or  a 
poultice,  or  that  the  hands  shall  reduce  a  hernia 

surgery,  that  is  to  say  to  use  the  knife  and  shed  human  blood 
or  to  use  the  actual  cautery,  and  even  to  study  medicine.  But 
during  the  crusades,  and  when  leprosy  was  imported  into 
Western  Europe,  the  lepers'  hospitals  were  attended  entirely 
by  monks. 

There  came  another  prohibition,  in  the  latter  part  of  the 
thirteenth  century,  under  the  pontificate  of  Boniface  VIII. 

The  law  of  celibary  imposed,  in  France,  upon  physicians, 
was  abrogated,  m  1452,  through  the  influence  of  Cardinal 
d'Etouteville.  This  should  have  placed  medicine  entirely 
in  the  hands  of  the  laity.  It  did  not  however ;  for  the 
clergy  continued  to  practise  medicine. 

The  final  decree  prohibiting  priests  from  practising  medicine 
or  surgery  was  promulgated  in  the  middle  of  the  eighteenth 
century  during  the  pontificate  of  Benedict  XIV.  (Diocesan 
decrees.  Book  XIII,  chapter  X.) 

Medicine  and  surgery  were  not  made  absolutely  distinct 
branches  until  the  fourteenth  century. 


MEDICINE   AND    SURGERY.  4I 

rather  than  percuss  a  chest  or  administer  a  po- 
tion. The  term  ''medicine"  was  applied  to  the 
healing  of  wounds  long  before  internal  diseases 
were  understood. 

The  term  chirurgery,  relating  to  manual  opera- 
tions, was,  according  to  Celsus,  not  used  until 
the  time  of  Herophilus  (307  B.  C).  A  few  cen- 
turies ago  the  word  surgeon  was  employed  to 
designate  the  "  barber-surgeon  "  in  contradistinc- 
tion from  the  educated  healer  who  was  styled 
"*'  Master  in  chirurgery." 

In  France,  as  early  as  the  beginning  of  the 
fourteenth  century,  no  barber-surgeon  was  per- 
mitted to  exercise  his  calling  until  he  had  been 
examined  by  certain  Masters  in  chirurgery.* 

It  would  seem  preferable  to  use  the  word  med- 
icine as  a  generic  term  and  to  arrange  the  science 
and  art  of  medicine  into  certain  departments  in 
accordance  with  the  several  apparatuses  of  the 
body  such,  for  instance,  as  relate  ;  (I,)  to  affec- 
tions of  the  cephalo-rhachidian  apparatus  and  of 
its  subsidiary  apparatuses  ;    (II,)  to  affections  of 


*  "  Rule  in  favor  of  the  Masters  in  chirurgery  of  the  month 
of  August  1301,"  contained  in  Girodat's  presentation  of  the 
case  of  the  surgeons  of  Paris  under  the  title  of  '•  Recherches 
Critiques  et  Historiques  sur  VOrigine,  sur  les  Divers  Etats, 
€t  sur  les  Pr ogres  de  la  Ckzrurgie  en  France,"  Paris  1744, 
p.  435. 


42  THE   PHYSICIAN. 

the  nutritive  apparatus  and  of  its  subsidiary  ap- 
paratuses;  (III,)  to  affections  of  the  motory 
apparatus  ;  (IV,)  to  affections  of  the  cutaneous 
apparatus  ;  and  (V,)  to  affections  of  the  generative 
apparatus  which  united  to  the  urinary  apparatus 
constitutes  the  uro-genital  apparatus. 

General  affections,  involving  several  appara- 
tuses, should  also  be  arranged  into  proper 
groups. 

THE   PHYSICIAN. 

The  ancient  Greeks  called  the  physicians 
idrpoiy  the  healer.  The  ideal  physician  should 
however  be  more  than  a  mere  healer  of  wounds 
or  a  prescriber  of  pills  and  potions. — Handicraft 
and  shrewdness  are  his  lowest  attributes. — He 
should,  in  a  broad  sense  ol  the  word,  be  a  philan- 
thropist (implying  not  only  a  lover  but  a  knower 
of  man),  and  a  close,  thoughtful,  observer  of  the 
nature  of  the  human  apparatuses,  the  disorders 
of  whose  functions  he  has  to  interpret.  He- 
should  investigate  questions  relating  to  the 
structural  and  other  characters  of  diseases.  He 
should  devise  means  for  the  cure  of  diseases,  and* 
formulate  rules  for  their  prevention.  He  should 
be  both  iatrosophisia  and  iatrotecJina,,  learned  in. 
the  science  and  skilled  in  the  art  of  medicine. 


43 

DEFINITION   AND    GENESIS   OF   DISEASE. 

In  this  connection  it  will  be  proper  to  answer 
the  commonly  asked  question  ;  "  What  is  meant 

by  disease?" 

Disease  is  a  deviation  from  the  normal  state 
of  the  whole  or  of  any  part  of  the  body. 

The  term  disease*  was  long  ago  introduced 
into  medical  language  to  express  the  idea  of 
bodily  uneasiness  or  distress  such  as  may  be 
caused  by  an  injury  ;  by  an  interruption,  or  a 
disturbance  of  vital  functions  ;  or  by  an  alteration 
in  the  structure  of  an  organ  or  of  several  organs 
of  an  apparatus  or  of  all  the  apparatuses  of  the 
body.  Hence  it  is  that  diseases  have  been  classed 
into  functional  and  organic  diseases.f  But  dis- 
ease of  an  organ  always  disorders,  in  a  greater 


*  The  etymology  of  the  word  disease  though  having  little 
scientific  value,  is  not  without  interest.  This  word  is  derived 
from  dis,  without,  and  ease,  through  the  old  French  desaise, 
lack  of  ease,  uneasiness,  distress. 

t  In  a  v/ritten  communication  on  this  subject,  Professor 
Meredith  Clymer  of  New  York  uses  the  following  language  : 
"  There  can  be  no  change  in  the  accustomed  expression  of  an 
activity — either  by  increase,  diminution  or  perversion — with- 
out coincident  change  in  the  plasmode.  Hence  strictly  there 
can  be  no  such  thmg  as  a  functional  as  distinguished  from  a 
structural  disease.  Disease  is  always  material,  whether 
recognisable  as  such  or  not." 


44        DEFINITION   AND   GENESIS   OF   DISEASE. 

or  less  degree,  the  function  of  the  apparatus  to 
which  it  belongs,  and  sometimes  disorders  the 
functions  of  several  apparatuses.  Therefore  such 
a  classification  is  faulty  and  misleading. 

The  affections  of  the   human  body  may  be  : 
(i.)  Congenital,  resulting  from  vices  of   the  pri- 
mary conformation  ; 
(2.)  Hereditary,  transmitted  by  progenitors  ; 
(3.)  Primary,    arising    from    more    or   less    well 

known  causes ; 
(4.)  Secondary,  consequent  upon  preexisting  dis- 
ease— in  this  case  the  word  pathengenetic  * 
expresses  briefly  the  idea  of  a  disease  spring- 
ing from  another  disease ; 
(5.)  Traumatic,  resulting  from  injuries  ;  or 
(6.)  May  be  the  outcome  of  errors  of  diet,  of  the 
effects  of  climate,  of  parasitic  invasion,  and 
of   gaseous,    mineral,    vegetable,    or    animal 
poisons, including  ptomaines  and  leucomaines. 
Although    these  affections  number  many   spe- 
cies,   the  morbid  states   and    morbific  processes 
from  which  these  species  originate   are  compara- 
tively few  and  are  comprised  under  the  follow- 
ing captions :  ( I,)  alterations  in   the   composition 
of  the  blood  ;  (2,)  disturbances  in  the  circulatory 


*  The  word  pathengenetic  was  lately  coined   by  Dr.  Alfred 
L.  Carroll. 


MORBID   STATES  &  MORBIFIC    PROCESSES.  '45 

apparatus  ;  (3,)  pathengenetic  alterations  of  struc- 
ture ;  (4,)  retrograde  metamorphoses;  (5,)  new 
growths;  (6,)  granulation-growths;  (7,)  cysts; 
(8,)  stones;  (9,)  injuries;  (10,)  monsters;  (11,) 
extraneous  bodies;  (12,)  parasites  ;  (13,)  poisons  ; 
(14,)  functional  disorders. 

SYNOPSIS  OF  THE  MORBID  STATES  AND  MORBIFIC 

PROCESSES  OF  THE  BODY,  BEING 

A  SUGGESTION  OF  A  GROUND  WORK  FOR  THE 

CLASSIFICATION  OF  DISEASES. 

I.  Alterationes  in  quantitate,  in  qualitate,  et  in 
compositione   sanguinis,    (Alterations  in  the 

quantity,  quality,  and  composition  of 
the  blood). 

1.  Hyperaemia,   (Superabundance  of  blood). 

2.  Hypoaemia,  (Insufficiency  of  blood). 

3.  Hyperhydraemia,  (Increase  of  blood- water). 

4.  Hypohydraemia,  (Decrease  of  blood-water). 

5.  Hyperinosaemia,   (Increase  of  blood-fibrin). 

6.  Hypoinosaemia,  (Decrease  of  blood-fibrin). 

7.  Hyperleucontaemia,*  (Increase  of  blood-albumen). 

8.  Hypoleucontaemia,  (Decrease  of  blood-albumen). 

9.  Hyperalonaemia,  (Increase  of  blood-salts). 
10.  Hypoalonaemia,  (Decrease  of  blood-salts.) 

II.  Hyperchromataemia,  (Increase  of  blood-color). 


*  XsvHoVf  the  white  of  an  egg — albumen. 


46      MORBID   STATES  &   MORBIFIC    PROCESSES. 

12.  Hypochromataemia,  (Decrease  of  blood-color). 

13.  Hyperleucoc3'thaemia,    (Increase   of   white   blood- 

cells). 

14.  Hypoleucocythaemia,    (Decrease   of   white   blood- 

cells). 

15.  Hypererythrocythaemia,    (Increase    of   red   blood- 

cells). 

16.  Hypoerythrocythaemia,    (Decrease   of   red   blood- 

cells). 

17.  Hyperlipaemia,  (Increase  of  blood-fat). 

18.  Hypolipaemia,  (Decrease  of  blood-fat). 

19.  Hyperphysaemia,  (Increase  of  blood-gas). 

20.  Hypophysaemia,  (Decrease  of  blood-gas). 

21.  Hyperglycaemia,  (Increase  of  blood-sugar). 

22.  Hypoglycaemia,  (Decrease  of  blood-sugar). 

23.  Acetonaemia,  (Acetone  in  the  blood). 

24.  Ammoniaemia,  (Ammonia  in  the  blood). 

25.  Hyperuraemia,  (Increase  of  blood-urea). 

26.  Hypouraemia,  (Decrease  of  blood-urea). 

27.  Hyperuricaemia,  (Increase  of  blood-uric  acid). 

28.  Hypouricaemia,  (Decrease  of  blood-uric  acid). 

29.  Cholaemia,  (Bile  in  the  blood). 

30.  Hypercholesteraemia,    (Increase   of    blood-choles- 

terin). 

31.  Hypocholesteraemia,    (Decrease    of    blood-choles- 

terin). 

32.  Melanaemia,  (Black  pigment  in  the  blood). 

33.  Septicaemia,  (Putrid  infection  of  the  blood). 

34.  Pyosapraemia,  (Putrid-pus  infection  of  the  blood). 


MORBID   STATES   &   MORBIFIC    PROCESSES.      4/ 

II.  Turbationes  in  apparatus  circulationis, 
(Disturbances  in  the  circulatory  apparatus). 

1.  Ischaemia,*  (Arrest  of  the  blood). 

2.  Athroisaemia,f  (Blood  accumulation,  congestion). 

3.  Phlegmasia,^  (Inflammation). 

4.  Lymphexomosis,  (Transudation  of  lymph). 

5.  Lymphorrhagia,   (Flow  from  a  rent  lymph-vessel). 

6.  Haemorrhagia,  (Flow  from  a  rent  blood-vessel). 

7.  Haemodiapedisis,     (Oozing    through     blood-vessel 

walls). 

8.  Thrombosis, §  (Coagulation). 

9.  Embolismus,!  (Plugging.) 

III.  Alterationes  structurae  pathengeneticae, 
(Pathengenetic  alterations  of  structure). 

1.  Hypertrophia,   (Hypertrophy). 

2.  Hypotrophia,   (Hypotrophy). 

3.  Atrophia,   (Atrophy). 

4.  Auxesis,  (Enlargement,  increase). 


*  Anaemia  localis,  (Local  capillary  anaemia). 

t  Athroisaemia,  from  dBpoi6}xa,  accumulation,  and  axiioLy 
blood.     Athroisaemia  activa  et  passiva.     Eff  usio  serosa. 

\  Exudationes. 

§  Angiohaemothrombus  (blood-vessel  clot),  cardiohaemo- 
thrombus  (heart  clot). 

I  Angioembolus,  (Vessel  plug). 


48      MORBID   STATES  &   MORBIFIC    PROCESSES. 

5.  Ectasis,  (Dilatation,  expansion). 

6.  Stenosis,  (Contraction,  stricture). 

7.  Echmasis,  (Obstacle,  obstruction). 

IV.  Metamorphoses  retrogrades, 
(Retrograde  metamorphoses). 

1.  Necrosis,*  (Necrosis,  death). 

2.  Meiosis,  (Meiosis,  decrease). 

3.  Degeneratio,t  (Degeneration). 

4.  Infiltratio,);  (Infiltration). 

V.  Neoplasmata,  (New-growths). 

(i.)  Desmoneoplasmata,  [Connective  tissue  neoplasms), 

1.  Endothelioma,  (Endothelioma). 

2.  Sarcoma,   (Sarcoma). 

3.  Inoma,  (Fibroma). 

4.  Myxoma,  (Myxoma). 

5.  Neuroglioma,  (Neuroglioma). 

6.  Lipoma,  (Lipoma). 

7.  Chondroma,  (Chondroma). 

8.  Osteoma,  (Obsteoma). 


*  Necrosis, — coagulationis,  colliquativa,  et  caseosa.  Gan- 
graena  humida  et  sicca.     Ulceratio. 

t  Degeneratio, — granulosa,  adiposa,  amyloides,  colloides, 
mucoides,  hyalina,  inoides,  et  sclerosa. 

X  Infiltratio, — adiposa,  pigmentaria,  calcarea,  et  urica. 


MORBID   STATES   &   MORBIFIC    PROCESSES.      49 

(2.)  Myoneoplasmata,  (Muscular  tissue  neoplasms\ 
I.  Myoma,*  (Myoma). 

(3.)  Neuroneoplasmata,  {Nerve  tissue  neoplasms). 
I.  Neuroma,  (Neuroma). 

(4.)  Angioneoplasmata^  {Vascular  tissue  neoplasms). 
I.  Angioma,!  (Angioma). 

(5.)  Epithelioneoplasmata^  {Epithelial  neoplasms.) 

1.  Epithelioma,   (Epithelioma). 

2.  Carcinoma,  (Cancer). 

3.  Adenoma,  (Glandular  growth). 

VI.  Blastomata,   (Granulation  growths), 

1.  Syphilis,  (Syphilis). 

2.  Ulcus  chancroides,   (Chancroid  ulcer). 

3.  Lepra,   (Leprosy). 

4.  Tuberculosis,  (Tuberculosis). 

5.  Lupus,  (Lupus). 

6.  Equinia,  (Glanders). 

7.  Actinomycosis,  (Actinomycosis). 

8.  Rhinoscleroma,  (Rhinoscleroma). 


*  Rhabdomyoma,  leiomyoma, 
t  Haemangioma,  lymphangioma. 


(St. 


50      MORBID   STATES  &   MORBIFIC    PROCESSES. 

VII.  Cystides,  (Cysts.) 

VIII.  Lithi,  (Stones). 

1.  Sialolithus,   (Salivary  stone). 

2.  Chololithus,   (Gall  stone). 

3.  Enterolithus,  (Intestinal  stone). 

4.  Urolithus,   (Urinary  stone). 

5.  Prostatolithus  (Prostatic  stone). 

6.  Piilebolithus,  (Vein  stone). 

IX.  Traumata,  (Injuries,)  including  all  kinds  of 

injuries  to  the  body. 

X.  Terata,    (Monsters,)    including  all    kinds   of 

congenital  anomalies  of  the  body. 

XI.  Corpora   extranea,   (Extraneous   bodies,)  in- 
cluding the  lodgment,  in  the  body,  of  all 

kinds  of  foreign  substances. 

XII.  Parasiti,  (Parasites). 

1.  Entozoa,  (Entozoa). 

2.  Ectozoa,  (Ectozoa). 

3.  Entophyta,    (Entophyta). 

4.  Epiphyta,  (Epiphyta). 


MORBID   STATES  &   MORBIFIC    PROCESSES.      5 1 

XIII.  Venena,  (Poisons,)   including  all   kinds  of 

gaseous,  mineral,  vegetable,   and  animal 

poisons. 


XIV.   Vitia  functionum,     (Disorders  of  the 
functions. 

1.  Perversio,  (Perversion). 

2.  Deficiens,  (Deficiency). 

3.  Immoderatio,  (Excess). 

4.  Diminutio,   (Diminution). 

5.  Suspensio,  (Suspension). 

6.  Abolitio,  (Abolition). 


COMMENTS   ON    SOME    OF    THE     TERMS    USED 

IN   THE   SYNOPSIS   OF   MORBID    STATES 

AND    MORBIFIC   PROCESSES. 

The  names  given  to  the  morbid  states  and 
morbific  processes  of  the  body  should  be  changed 
whenever  the  true  nature  of  these  states  and  pro- 
cesses is  discovered.  Many  of  the  names  only 
convey  an  erroneous  idea  of  the  condition  which 
they  are  intended  to  express. 

The  term  inflam7nation^  for  instance,  is  used 
under  protest  until  a  better  term  shall  be  agreed 


52  TERMS   USED   IN  THE   SYNOPSIS   OF 

upon  by  the  profession.  The  coinage  of  this 
word  is  based  upon  symptoms  and  not  upon 
morbid  properties.  When  the  exact  pathic  con- 
dition of  this  so  called  inflammatory  process  is 
clearly  defined,  the  proper  name  will  be  found, 
and  when  this  is  found,  words  will  probably  be 
coined  in  place  of  those  ending  in  itis  to  denote 
inflammation  of  particular  parts  of  the  body. 

Auxesis'^  is  placed  under  the  caption  alterations 
of  structure  because  increase  in  bulk  of  an  organ 
may  and  does  occur  independently  of  what  is 
called  inflammation.  This  word  is  substituted 
for  hypertrophy  which  ordinarily  is  improperly 
used  in  the  sense  of  augmentation.  Hypertrophy 
neither  means  nor  does  it  even  imply  enlarge- 
ment. It  signifies  over-nourishment,  the  opposite 
of  no  nourishment  or  atrophy.  When  the  body 
is  over-fed,  the  organs  do  not  of  necessity  en- 
large, but  much  of  the  surplus  nourishment  is  de- 
posited, in  the  form  of  fat,  under  the  skin,  in  the 
mesentery,  and  around  the  kidneys;  this  is  an 
example  of  true  hypertrophy.  The  organs  of 
the  human  body  receive  nourishment  to  the  ex- 


*  Auxesis,  from  av^7^6ii,  increase,  augmentation  enlarge- 
ment. 


MORBID    STATES  &   MORBIFIC    PROCESSES.      53 

tent  of  their  requirements,  neither  more  nor  less 
whatever  may  be  their  condition.  When,  from 
disease,  an  organ  slowly  increases  in  size  and 
afterwards  does  not  tend  to  decrease,  the  calibre 
and  length  of  its  nutrient  arteries  are  often 
found  to  be  increased  and  the  thickness  of  the 
walls  of  these  vessels  is  also  proportinately  aug- 
mented. This  condition  of  the  blood  vessels  is 
not  ordinarily  called  hypertrophy.  It  is  assuredly 
a  great  inconsistency  to  apply  the  term  hyper- 
trophy to  an  enlarged  organ  and  not  to  its  en- 
larged arteries.  The  careful  study  of  the  morbid 
anatomy  of  enlarged  organs  shows  that  the 
auxesis  has  a  cause  entirely  foreign  to  over- 
nourishment.  The  disturbing  element  may  or 
may  not  be  carried  to  it  by  the  blood,  and  when 
it  is  so  carried,  the  enlargement  is  due  to  this  dis- 
turbing element  and  not  to  the  quantity  of  blood 
which  is  only  proportionate  to  the  demand  of  the 
organ  for  its  adequate  nutrition.  A  liver  enor- 
mously enlarged  from  cancerous  disease  is  not 
generally  called  hypertrophied,  and  yet  it  may 
receive  one  third  more  blood  than  when  it  was  in 
a  normal  condition.  A  large  fatty  liver  is  called 
a  fatty  and  not  a  hypertrophied  liver.  The  well 
developed  muscles  of  the  athlete  are  not  over- 
nourished.  If  they  were,  he  would  probably  be 
unfit  to  perform  his  feats  of  strength  and  agility. 


54  TERMS    USED   IN   THE   SYNOPSIS   OF 

The  enlarged  heart  is  not  over-nourished  ;  it  is 
as  likely  to  be  inadequately  fed. 

The  only  other  instance  of  hypertrophy  is  that 
which  occurs  in  the  beginning-  of  certain  varieties 
of  local  inflammation  when,  for  a  short  period, 
the  parts  are  over-fed  owing  to  an  undue  activity 
in  the  circulation.  This  may  soon  be  followed  by 
stasis  of  blood  in  the  capillaries.  During  the 
static  period  there  is  hypotrophy — diminished 
nutrition,  under-feeding — ,  and  if  the  stasis  per- 
sist, nutrition  ceases.  Here  then  is  true  atrophy. 
The  part  that  is  no  longer  nourished  dies.  This 
is  what  is  commonly  called  mortification  which 
is  regarded  as  an  unfavorable  termination  of  the 
inflammatory  process.  Marasmus,  and  the  ema- 
ciation which  occurs  in  phthisis  pulmonalis  or  in 
the  course  of  febrile  disorders,  such  as  typhus 
and  typhoid  fevers  ;  in  the  course  of  cancerous 
affections ;  in  chronic  pyelo-nephritis ;  and  in 
saccharine  diabetes,  exemplify  hypotrophy.  An 
organ  which  has  decreased  in  size  may  be  called 
meiomous.^ 

Hypertrophy  and  atrophy  are  correctly  coined, 
and  good  words  in  their  proper  places.  It  is 
only  their  misuse  that  is  here  criticised. 

The    words   hypertrophy    and  atrophy  of  the 


*  Meiomous,  from  nEiGoj.ia,  a  decrease. 


MORBID    STATES   &    MORBIFIC   PROCESSES.      55 

kidneys  which  are  employed  in  the  Enghsh  no- 
menclature of  diseases  in  the  year  1869  are  re- 
jected in  the  revision  of  1885.  The  hypertrophy 
referred  to  was  presumably  applied  in  1869  to 
the  form  of  disease  now  called  in  the  revised 
edition  of  1885  "large  white  kidney  of  nephri- 
tis "  which  is  a  condition  of  auxesis  or  enlarge- 
ment. In  like  manner  atrophy  was  employed  in 
1869,  but  to  express  the  opposite  condition  now 
known,  and  classified  in  the  revised  edition,  as 
contracted  kidney,  which  is  a  decreased  or  mei- 
omous  kidney,  a  retrograde  metamorphosis.  It 
seems  clear  in  both  these  instances  that  the  word 
hypertrophy  and  atrophy,  used  in  1869  in  the  case 
of  the  kidney,  failed  to  convey  an  adequate  idea, 
in  the  minds  of  the  revisers,  of  the  pathic  condi- 
tions in  question,  or  else,  in  the  revision  of  1885, 
they  would  not  have  been  abandoned. 

If  therefore  this  interpretation  of  the  omission 
be  correct,  why  should  it  not  be  applied  to  all 
cases  where  the  word  hyphertrophy  is  used  in 
the  sense  of  increase  in  bulk,  and  atrophy  in  the 
sense  of  diminution  ? 

Auxetic  affections  may  be  echmatic  as  in  cer- 
tain types  of  enlargement  of  the  prostrate,  or 
may  not  be  echmatic  as  in  uniform  enlargement 
of  the  prostate  which  does  not  impede  the  flow 


$6  TERMS    USED    IN   THE   SYNOPSIS   OF 

of  urine.  Some  auxetic  affections  are  neoplastic, 
others  are  pathengenetic. 

The  words  hypertrophy  and  atrophy  will  not 
be  employed  in  this  work  except  when  in  their 
true  meaning,  they  are  absolutely  required. 

Stenosis*  is  generally  the  outcome  of  inflamma- 
tory action.  Stenotic  affections  are  pathic  con- 
ditions of  the  excretory  ducts  and  of  hollow 
viscera  by  which  these  ducts  are  narrowed  and 
the  viscera  lessened  in  capacity,  as  in  the  case  of 
stenosis  or  stricture  of  the  urethra  or  in  the  case 
of  a  permanently  contracted  bladder  with  mark- 
edly diminished  capacity.  A  stenotic  affection 
may  or  may  not  be  echmatic.  It  is  often  echmatic 
in  stricture  of  the  urethra,  but  not  in  stenosis  of 
the  bladder.  Stenotic  affections  are  sometimes 
congenital,  sometimes  traumatic,  but  most  fre- 
quently they  are  pathengenetic,t  that  is  to  say 
are  the  sequelae,  the  offspring"  of,  or  are  engen- 
dered by  a  preexisting  morbid  condition,  as  for 
instance,  the  strictures  which  result  from  ureth- 
ritis, or  the  stenosis  of  the  bladder  springing 
from  inflammation  of  that  viscus. 


*  Stenosis,  from  drsruco,  to  make  narrow,  to  contract. 
t  Pathengenetic,    from   TtaQo?,    a    disease,    and    eyyevrfi, 
sprung  from.  (Carroll.) 


MORBID   STATES  &   MORBIFIC    PROCESSES.      5/ 

Ectasis  *  is  a  condition  of  expansion  or  dilata- 
tion of  certain  serous  cavities,  hollow  viscera, 
excretory  ducts,  and  lymphatic  and  blood  vessels. 
Stenotic  affections  are  pathengenetic,  and  due  to 
inflammatory  action,  or  to  obstruction  from  dis- 
ease or  from  the  lodgment  of  a  foreign  body. 
Morbid  dilation  of  the  bladder,  general  or  local, 
is  an  ectatic  affection.  A  so  called  hydrocele  of 
the  tunica  vaginalis  gives  rise  to  ectasis  of  the 
tunica  vaginalis. 

Echmasis  f  may  result  from  inflammation,  from 
a  neoplasm,  or  from  the  lodgment  of  a  foreign 
body.  Echmasis  is  here  used  in  preference  to 
epischesis  of  which  Vogcl  makes  a  class  and 
Cullen  an  order.  Epischesis,  from  snexsiv,  to  hold 
up,  to  check,  to  restrain,  is  defined  as  a  suppres- 
sion of  excretions.  Echmasis  defines  more 
exactly  the  character  and  the  cause  of  the  sup- 
pression of  the  excretion,  as  in  the  case  of  reten- 
tion of  urine  in  the  bladder,  which  generally  has 
for  its  cause  a  material  obstruction  in  the  urinary 
passage,  such  as  stricture  of  the  urethra  or  en- 
largement of  the  prostrate.  Echmatic  affections 
may  therefore  be  also   stenotic  or  auxetic,   and 


*  Ectasis,  from  sk,  out,  and  vEiveiv,  to  stretch,  expand, 
or  extend. 
t  Echmasis,  from   '^XJJ'0(-i  obstruction,  obstacle,  hinderance. 


S8  TERMS   USED    IN  THE    SYNOPSIS. 

they  may  be  pathengenetic,  that  is  to  say  may 
spring  from  or  be  engendered  by  a  preexisting 
pathic  condition. 

Blastoina  "^  should  be  substituted  for  granuloma 
which  is  a  h3^brid  word  meaning,  according  to 
Dunglison,  ''  a  morbid  product  formed  by  parti- 
tion and  multiplication  of  the  connective  tissue 
cells  into  groups  of  others  resembling  lymph 
cells,  lying  in  an  intercellular  substance,  with  a 
tendency  to  fatty  degeneration  ;  as  elephantiasis 
ifiraecoruni),  lupus,  etc."  The  same  author  de- 
fines a  granule  as  ''  a  small  grain,  a  compact  par- 
ticle, a  cytoblast."  The  French  name  for  granu- 
lation is  bourgeon  charnu,  fleshy  bud.  Blastoma 
seems  to  express  the  meaning  intended  to  be  con- 
veyed by  granuloma,  and  something  more,  for 
the  blastomata  are  now  regarded,  by  many  his- 
tologists,  as  affections  caused  by  the  presence  of 
microorganisms,  and  on  this  account  also  the 
word  blastoma  is  preferable  to  granuloma  which, 
besides  being  an  ill-formed  word,  fails  to  convey 
the  idea  of  a  germ  disease. 

The  term  disorder  \  is  applied  to  functional  af- 
fections, e.  g.,  disorder  of  a  function,  or  func- 
tional disorder.     An  organ  is  said  to  be  diseased, 


*  Blastoma,  from  ftXadroi,  shoot,  bud,  germ,  and  ca/za. 
t  Disorder,  from  dis  without,  and  order. 


PROPER   ANATOMICAL   TERMS.  59 

but  a  function  disordered.  Functional  disorders 
are  caused  by  disease  of  one  or  of  more  than  one 
organ  of  an  apparatus.  It  is  often  difficult  and 
sometimes  impossible  to  ascertain  which  of  the 
organs  of  an  apparatus  is  so  diseased  as  to  dis- 
order the  function  of  that  apparatus. 

Of  the  six  genera  of  functional  disorders  enu- 
merated in  the  synopsis  of  morbid  states  and 
morbific  processes,  only  four  were  formerly 
recognised.  It  has  seemed  proper  to  add  de- 
ficiency (2),  which  is  exemplified  by  the  lessening" 
of  urea  in  the  urine,  and  suspension  (5),  which  is 
exemplified  by  anuria,  and  also  by  retention  of 
urine. 

THE   VALUE    AND    SIGNIFICANCE    OF     PROPER 
ANATOMICAL  TERMS   IN   CLASSIFICATION. 

Certain  explanatory  comments  are  now  due  re- 
specting this  proposal  for  the  establishment  of  a 
stable  basis  for  the  nomenclature  and  classifica- 
tion of  diseases  in  general  and  of  affections  of  the 
uro-genital  apparatus  of  the  male  in  particular. 

In  accordance  with  the  definition  given  of  the 
word  disease,  parasitic  affections ;  congenital  ab- 
normities ;  the  lodgment,  in  the  body,  of  extrane- 
ous substances  or  of  poisons ;  and  injuries  ;  may, 
with  propriety,  be  classed  among  the  diseases  of 


6o        PROPER  ANATOMICAL  TERMS 

man,  for  they,  also,  interrupt  or  they  disturb 
vital  functions.  At  the  same  time  the  word 
affection  may  be  used  as  an  equivalent  term 
to  disease  whenever  it  is  found  convenient ; 
for,  although  an  affection  does  not  always  imply 
the  existence  of  an  organic  morbid  condition  with 
structural  change,  all  diseases  are  affections.  For 
instance  man  may  be  affected  with  a  congenital 
malformation,  or  an  injur}^,  as  well  as  with  a 
disease  in  which  there  is  alteration  of  structure 
or  impairment  of  function. 

Apparatus  is  used  instead  of  system  for  the 
reasons  herein  given. 

English  speaking  authors  of  high  reputation 
have,  for  a  long  time  past,  made  use  of  the 
phrase  genito-urinary  system,  although  the  word 
system,  in  this  sense,  is  so  obviously  inappropri- 
ate. A  critical  examination  of  the  subject  will 
not  fail  to  convince  the  inquirer  that  system,  in 
this  particular  sense  has  been  misapplied  if  he 
take  the  pains  to  consult  the  standard  medical 
dictionaries. 

The  word  system,^  when  used  in  the  anatomical 
sense,  signifies  an  assemblage  of  organs  composed 
of  the  same  tissues  and  intended  for  similar  uses, 
as  for   instance  the   nervous  system   (system  of 


*  System,  from  iv'iTrjfxa,  from  'ivviir-qf.n  to  place  together. 


IN    CLASSIFICATION.  6l 

nerves),  the  arterial  system,  the  venous  system, 
the  lymphatic  system,  the  muscular  system,  the 
osseous  system,  the  ligamentous  or  desmic  sys- 
tem, etc.  Systems  have  general  uses,  but  per- 
form no  functions.  They  are  all  contained  in 
apparatuses,  to  which  they  yield  service. 

In  the  nomenclature  of  diseases  prepared  by 
the  joint  committee  appointed  by  the  Royal  Col- 
lege of  Physicians  of  London  (1869),  system  is 
throughout  used  instead  of  apparatus  with  the 
exception  of  the  phrase  "  lacrymal  apparatus." 
The  use  of  the  word  apparatus  in  this  isolated 
case  would  seem  to  be  an  inconsistency.  The 
term  apparatus  being  however  accepted  as  the 
designation  of  the  group  of  organs  by  which  the 
tears  are  secreted  and  conveyed  into  the  nasal 
cavity,  it  is  evident  that  the  groups  of  organs 
which  perform  the  functions  of  sight,  hearing, 
smell,  taste,  respiration,  digestion,  urination, 
generation,  etc.,  should  be  regarded  as  so  many 
apparatuses. 

In  the  first  decennial  revision  (1885)  of  this 
same  nomenclature,  the  word  system  continues 
to  be  used  for  apparatus,  except  as  before,  in  the 
case  of  the  lacrymal  apparatus.  But  in  the  cap- 
tion which  preceeds,  the  revisers  m.ake  use  of  the 
term  apparatus  in  a  singularly  inappropriate 
sense,  i.  e.  "  Disorders  of  the  muscular  appara- 


62  PROPER  ANATOMICAL   TERMS 

tus  "  of  the  eye.  The  visual,  like  the  other  ap- 
paratuses of  the  body,  contains  parts  of  several 
systems ;  therefore  muscular  system  of  the  eye 
should  have  been  used  instead  of  muscular  ap- 
paratus^ since  there  is  not,  in  anatomy,  any  rec- 
ognition of  a  muscular  apparatus.  Again,  in  this 
same  edition  of  the  London  nomenclature,  ap- 
paratus is  used  where  system  should  have  been 
applied,  e.  g.,  "  Nervorum  apparatus  morbid  The 
nervous  system  yields  service  to  the  cephalo- 
rhachidian  and  other  apparatuses,  but  there  is  no 
nervous  apparatus.  Another  example  is  in  the  case 
of  "  Diseases  of  circulatory  j^j/^w,"  latinised  into 
^^  Sa7iguinis  apparatus  morbid  The  circulatory 
apparatus  comprises  a  system  of  arterial,  of 
venous,  and  of  lymphatic  vessels,  with  certain 
reservoirs,  and  a  pump  to  carry  on  the  circula- 
tion. Therefore  there  exists  neither  a  blood  ap- 
paratus nor  a  circulatory  system,  but  properly  a 
circulatory  apparatus.  Still  another  inconsis- 
tency may  be  noticed  in  the  case  of  "  Diseases  of 
the  respiratory  system,  ''  latinised  into  "  Spiritus 
organorum  morbi,''  and  why  not  here  apparatus 
instead  of  organs,  since  the  next  Latin  caption  is 
*'  concoctionis  apparatus  7?zorbi,''  which  is  translated 
into  ''  Diseases  of  the  digestive  system  "  ? 

These   may  perhaps  be   regarded   as   fair  ex- 


IN   CLASSIFICATION.  6^ 

amples  of  the  many  defects  which  seriously  mar 
the  modern  English  system  of  nomenclature. 

An  organ,"^  in  anatomical  parlance,  is  a  part  of 
the  body  designed  to  contribute  its  share  to 
whatever  may  be  necessary  for  the  completion  of 
a  function.  An  organ  may  aid  in  the  performance 
of  two  or  more  than  two  entirely  different  func- 
tions. For  instance  the  urethra,  while  it  trans- 
mits the  urine  is  a  urinary  organ,  and  while  it 
transmits  the  semen  it  is  a  genital  organ  ;  and 
there  is  no  lack  of  other  equally  good  examples  in 
human  anatomy.  Therefore  an  organ  performs 
no  function,  being  simply  one  of  an  assemblage 
of  instruments  constituting  an  apparatus,  which 
alone  can  perform  a  function,  that  is  to  say  bring 
it  to  its  completion. f  "■  In  the  organs  of  a  system 
of  organs  there  is  analogy  of  structure,  while  in 
the  organs  of  an  apparatus  there  is  analogy  only 
of  function."  :|: 


*  Organ,  from  opyavov,  an  instrument. 

t  An  organ,  like  a  system,  yields  service  to  an  apparatus  ia 
the  performance  of  its  function,  or  to  two  or  more  than  two 
apparatuses.  Hence  it  is  rightly  said  that  an  organ  has  its 
uses,  while  an  apparatus  performs  its  one  function. 

X  Dunglison,  Littre  and  Robin,  and  Dechambre,  Duval  and 
LerebouUet. 


64        PROPER  ANATOMICAL  TERMS 

All  apparahis^  of  the  human  body  is  an  as- 
semblage of  organs  which  work  toward  the  same 
end  or,  in  other  words,  v/hich  concur  in  a  common 
function,  though  they  be  of  different  nature.  An 
apparatus  then  comprises  organs  of  differing 
anatomical  constitution.  An  apparatus  may  be 
composed  of,  or  may  contain,  several  other  ap- 
paratuses. For  instance,  the  primary  human  ap- 
paratus consists  of  five  secondary  apparatuses 
which  contain  sixteen  subsidiary  apparatuses. 

The  secondary  apparatuses  of  the  body  are : 
(I,)  the  cephalo-rhachidian  apparatus,  containing 
the  subsidiary  apparatuses,(i ,)  of  vision — including 
(2,)  the  lacrymal  apparatus — ,  (3,)  of  audition,  (4,) 
of  olfaction,  and  (5,)  of  gustation  ;  (II,)  the  nutri- 
tive apparatus  containing  the  subsidiary  appara- 
tuses, (6,)  of  mastication,  (7,)  of  deglutition,  (8,) 
of  digestion,  (9,)  of  absorption,  (10,)  of  circula- 
tion, (11,)  of  respiration,'!' — containing  (12,)  the 
apparatus  of  phonation — ,  (13,)  of  urination,  and 
(14,)  of  defecation;  (III,)  the  motory  apparatus ; 
(IV,)   the  cutaneous  apparatus,    containing  (15,) 


*  Apparatus,  from  the  prefix  ad,  and  parare,  paratutn,  to 
prepare. 

t  The  respiratory  apparatus  contains,  but  is  subsidiary  to, 
the  phonetic  apparatus  which  is  subsidiary  to  the  cephalo- 
rhachidian  apparatus. 


IN   CLASSIFICATION.  65 

the  apparatus  of  touch,*  and  (16,)  the  apparatus 
of  transpiration ;  f  and  (V,)  the  apparatus  of 
generation. 

The  secondar}^  apparatus  of  generation  and  the 
subsidiary  apparatus  of  urination  bear  such  close 
anatomical  relations  to  each  other  that,  for  clin- 
ical purposes,  they  should  be  united  under  the 
name  of  the  uro-genital  apparatus. 

Parts  of  several  systems  are  included  in  an  ap- 
paratus as,  for  instance,  nerves,  vessels,  glands, 
muscles,  bones,  cartilages,  ligaments,  connective 
tissue,  mucous  membranes,  etc.  Each  apparatus 
accomplishes  only  one  function,  while  each  organ 
of  that  apparatus  may  have  several  uses.  There 
is  no  apparatus  but  performs  a  function,  and 
there  is  no  function  without  an  apparatus  (Robin), 
man  himself  being  a  grand  primary  apparatus 
destined  to  perform  only  one  function.:]: 


*  The  tactile  apparatus  is  subsidiary  to  the  cephalo-rhachi- 
dian  apparatus. 

t  The  transpiratory  apparatus  is  subsidiary  to  the  nutritive 
apparatus. 

I  Inasmuch  as  the  views  above  expressed  have  been  charac- 
terized as  allied  to  positivism,  it  is  proper  that  some  notice  be 
here  taken  of  this  assertion.  The  subject  under  consideration 
js  man's  body,  not  his  soul ;  his  anatomy,  not  his  psychology. 
Anatomy,  in  all  its  branches,  teaches  nothing  contrary  to  be- 
lief in  an  Almighty  God  Creator  of  all  things.    A  firm  believer 


66  PROPER  ANATOMICAL  TERMS 

The  primary  apparatus  man  then,  consists  of 
an  assemblage  of  secondary  apparatuses  ;  a  sec- 
ondary apparatus  consists  of  an  assemblage  of 
subsidiary  apparatuses  ;  and  a  subsidiary  appara- 
tus consists  of  an  assemblage  of  organs  and  ot 
parts  of  systems. 

A  function  "^  is  the  act  accomplished,  not  by  an 
organ  or  a  system  of  organs,  but  by  an  appara- 
tus which,  as  already  stated,  consists  of  an  as- 
semblage of  differing  organs.  Therefore  the  use 
of  the  word  function  should  be  restricted  to  the 
act  of  an  apparatus. 

If  the  following  comparison  be  allowable,  the 
human  apparatus  may  be  likened  to  a  grand 
orchestra  consisting  of  many  differing  musical  in- 
struments and  of  men  to  perform  thereon.  The 
function  of  each  performer  and  his  instrument 
being  music.  In  this  case  each  instrument  is 
passive  until  it  is  played  upon,  when  it   becomes 

in  God,  who  masters  anatomy  discovers  therein  nothing  to 
disturb  his  creed.  Anatomy  can  deal  with  only  what  is  finite 
in  man  ;  but  with  the  infinite  part  of  man,  that  which  is  God- 
like, it  can  have  nothing  to  do,  and  on  this  immortal  part  of 
man,  it  can  have  nothing  to  say  worth  hearing,  nor  is  it  ever 
likely  to  shake  the  faith  that  is  once  well  implanted  in  any 
mind. 

*  Function,  ftmctio  from  fimgt,  fuftctus,  to  act,  to  per- 
form. 


IN   CLASSIFICATION.  6/ 

a  secondary  apparatus,  and  a  collection  of  such 
secondary  apparatuses  constitutes  the  grand 
orchestra  or  primary  apparatus  whose  function 
is  JLarvio7iioiis  music. 

Doctor  Meredith  Clymer  defines  "  a  function 
as  the  sum  of  the  automatic  activities  of  the  or- 
gans which  go  to  make  up  an  apparatus,  and 
says ;  an  organ  *  yields  service  to  an  apparatus, 
but  it  can  only  do  this  by  being  put  into  act,  and 
that  act  must  be  the  result  of  an  autonomous,  in- 
hering property,  a  potentiality,  set  free  by  a  lib- 
crating  force.  The  product  is  an  activity  or  func- 
tion. An  organ  can  yield  no  service  in  a  passive 
state.  It  must  be  in  an  active  state,  and  it  cannot 
do  or  be  active  without  a  transformation  of  po- 
tential mto  kinetic  energy  by  the  liberation  of 
energy.*  " 

Doctor  Clymer  is  known  to  be  a  close  reasoner 
and  to  be  convincing  by  his  sound  arguments, 
therefore  it  is  not  easy  to  venture  upon  anything 
like  opposition  to  the  views  he  so  lucidly  puts 
forth  ;  nevertheless  an  attempt  will  be  made  to 
find  therein  a  possible  flaw. 

The  "activities"  of  organs  are  unquestioned,, 
but  if  each  of  these  organs  be  isolated,  its  activ- 
ity is   insufficient   to    constitute    a  function   in  a 


*  From  a  written  communication. 


68  PROPER   ANATOMICAL  TERMS 

physiological  point  of  view.  The  organ  must 
have  the  concurrence  of  other  organs,  or  the 
function  cannot  be  completed,  in  other  words, 
the  function  can  be  performed  only  by  an  as- 
semblage of  organs  of  differing  anatomical  prop- 
erties. Each  organ  contributing  its  share  of 
activity  toward  the  elaboration  and  completion 
of  the  function.  To  this  assemblage  of  differing 
organs,  the  name  of  apparatus  has  been  given, 
and  the  apparatus  performs  the  function  which 
is  the  terminal  act. 

The  Doctor's  definition  of  function  is  excellent 
and  is  in  harmony  with  the  views  contained  in 
this  work,  but  does  not  precisely  agree  with 
what  follows,  for  if  the  ''  automatic  activities  " 
of  certain  organs  go  to  make  up  the  function  of 
an  apparatus,  which  is  it  that  performs  the  func- 
tion ?  Is  it  each  organ  or  every  organ  ?  Is  it 
not  all  the  organs  together,  of  the  apparatus, 
rather  than  each  organ  separately?  If  each  organ 
separately,  then  an  assemblage  of  organs,  consti- 
tuting an  apparatus,  would  perform  as  many 
functions  as  there  are  in  it  organs.  But  the  con- 
trary is  known  to  be  the  case  in  physiology.  For 
instance,  the  function  digestion  is  "  the  sum  of 
the  automatic  activities "  of  the  organs  which 
constitute  the  digestive  apparatus.  The  function 
motion  is  "  the  sum  of  the  automatic  activities  ' 


IN   CLASSIFICATION.  69 

of  the   organs  which  constitute   the   motory  ap- 
paratus, etc. 

Littre  and  Robin  define  the  fujiction  of  an  ap- 
paratus (in  anatomy)  as  the  special  act  whicli 
each  apparatus  executes,  and  define  the  uses  of 
organs,  as  the  acts  executed  by  each  organ.  One 
and  the  same  organ  having  several  uses,  while 
an  apparatus  performs  only  one  function.  '^  One 
and  the  same  muscle  may  aid  in  the  flexion  and 
rotation  of  a  limb.  The  jaw  is  used  in  mastica- 
tion and  in  phonation,  etc.  The  word  use  should 
not  be  confounded  with  the  word  /miction  which 
has  an  entirely  different  signification.""^ 

The  difificulty  arising  from  the  employment  of 
these  terms  does  not  lie  in  the  interpretation  of 
the  acts  themselves,  but  in  language,  in  the 
modes  of  denoting  and  of  differentiating  the 
several  acts.  It  is  to  be  hoped  that  a  suitable 
word,  other  than  use  or  function,  will  be  found 
to  express  a  corect  idea  of  the  activity  of  an 
organ.  The  word  function  however  seems  w^ell 
adapted  to  denote  the  act  of  an  apparatus.  Its 
use  should  be  so  restricted.  Therefore,  until  a 
better  word  is  suggested,  the  term  function  \vill 


*  Dictionnaire  de  Medicine,  de  Chirurgie,  etc.  D'apres  le 
plan  suivi  par  Nysten.  Douzieme  edition.  Par  E.  Littre  et 
Ch.  Robin,  Paris,  1865. 


70        PROPER  ANATOMICAL  TERMS 

be  used,  in  this  work,  in  connection  with  the  act 
of  an  apparatus. 

May  not  the  word  faculty  be  applied  to  the 
activity  of  an  organ,  as  for  example,  the  gly- 
cogenic faculty  of  the  liver  ? 

Crabb  defines  "  a  faculty  as  a  specific  power 
which  is  directed  to  one  single  object ;  it  is  the 
power  of  acting  according  to  a  given  form." 

Lewes,  in  commenting  upon  faculty  and  func- 
tion, says :  "  ...  By  faculty  is  commonly  under- 
stood the  power  or  aptitude  of  an  agent  to  per- 
form a  certain  action  or  class  of  actions.  It  is 
thus  synonymous  with  function,  which  means  the 
activity  of  an  organ,  the  uses  of  the  instrument. 
I  propose  to  detatch  faculty  from  this  general 
signification,  limiting  it  to  the  action  or  class  of 
actions  into  which  a  function  may  be  diversified 
by  the  education  of  experience.  That  is  to  say, 
let  function  stand  for  the  native  endowment  of 
an  organ,  and  faculty  for  its  acquired  variation  of 
activity."  * 

If  the  word  faculty  be  used  to  denote  the  act, 
the  use,  the  aptitude,  of  an  organ,  it  should  not 
be  detatched  from  its  general  signification  and 
should  "  stand  for  the  native  endowment  of   an 


*  Problems  of  Life   and  Mind.     By  George  Henry  Lewes. 
American  edition.  Boston,  1879,  p.  27. 


IN   CLASSIFICATION.  7I 

organ,"  and  function  should  be  restricted  to  the 
act  of  an  apparatus. 

One  of  the  conclusions  drawn  from  the  forego- 
ing considerations  is  that  there  is  no  urinary 
systein.  The  kidneys  are  the  uropoietic  organs 
of  the  urinary  apparatus ;  they  secrete  the  ma- 
terials which  enter  into  the  composition  of  the 
urine ;  in  them  the  urine  is  concocted  and  is  then 
transmitted  by  their  excretory  ducts  to  its  proper 
reservoir.  The  urinary  organs  are  the  kidneys ; 
their  excretory  ducts,  the  ureters  ;  and  the  grand 
reservoir  of  the  urine,  the  bladder.  These  organs, 
together  with  the  urethra  and  the  prostate,  con- 
stitute the  urinary  apparatus.  It  is  by  means  of 
this  apparatus  that  the  function  of  elimination, 
from  the  body,  of  certain  effete  substances,  is 
brought  to  its  completion. 

Another  conclusion  is  that  there  is  no  geni- 
tal system.  The  testicles  are  simply  the  spermo- 
poietic  organs  of  the  genital  apparatus.  The 
genital  organs  are  the  testicles  ;  the  deferential 
canals ;  and  the  seminal  vesicles ;  these  organs 
together  with  the  urethra,  the  prostate,  and  the 
penis,  constitute  the  genital  apparatus  by  which 
the  function  of  generation  is  accomplished  under 
proper  conditions. 

The  uro-gemtal  apparatus  comprises  the  urin- 
ary apparatus  and  the  genital  apparatus. 


72        PROPER  ANATOMICAL  TERMS. 

The  organs  of  the  urinary  apparatus  and  those 
of  the  genital  apparatus  are  so  intimately  asso- 
ciated and  so  interdependent  that  they  must  act 
in  perfect  harmony  or  the  double  apparatus  is 
affected  in  a  greater  or  less  degree.  Diseases  of 
any  of  the  urinary  organs  cause  some  derange- 
ment of  the  others  and  disturb  the  genital  organs 
and  often  the  whole  organism. 


SECTION  II. 

Human  Nosography. 

A  summary  of  the  progress  of  nosography  since  its  founda- 
tion. The  scope  of  nosography.  Notice  of  Sauvages.  A 
consense  of  views  necessary  in  methodical  arrangement. 
Synopses  of  Sauvages',  CuUen's,  Parr's,  Good's  and  Delorme's 
arrangements  of  diseases.  Comments  on  these  several  systems. 
Cullen's  rules  for  distinguishing  genera,  species,  and  varieties 
of  diseases.  Parr's  rules.  Some  of  the  aphorisms  relating  to 
classification,  extracted  principally  from  the  philosophia 
botanica  of  Linnaeus,  by  Doctor  Thomas  Young. 

ORIGIN  AND   PROGRESS   OF  NOSOGRAPHY. 

An  outline  of  the  development  of  nosography 
may,  with  advantage,  be  traced  from  its  founda- 
tion to  the  present  time,  and  be  followed  by  a 
brief  commentary  upon  the  methods  employed 
by  some  of  the  nosographers  of  the  last  and  of 
this  century. 

Nosography  is  in  reality  the  science  of  medi- 
cine and  therapy  is  its  art.  Nosography  in- 
cludes the  description,  the  definition,  the  nomen- 
clature, and  the  classification  of  diseases.  A 
knowledge  of  the  several  branches  of  anatomy 
is  the  essential  preliminary  to  the  study  of  noso- 


74      ORIGIN   AND    PROGRESS    OF   NOSOGRAPHY. 

graphy.  The  physician  who  is  thoroughly 
acquainted  with  this  science  is  a  master  of  the 
natural  history  of  diseases.  The  training  neces- 
sary to  its  acquirement  gives  him  a  precision  in 
diagnosis,  and  a  degree  of  wisdom  in  prognosis 
and  of  skill  in  therapy,  to  which  otherwise  he 
could  never  attain. 

The  word  nosography*  is  of  comparatively 
modern  application.  It  was  not  in  use  among  the 
ancient  physicians. f  Although  the  study  of  the 
history  of  diseases  began  Avith  the  founder  of 
medical  art  and  was  faithfully  continued  by  his 
successors,  no  attempt  at  their  classihcation 
seems  to  have  been  made  until  about  the  close  of 
the  sixteenth  century.  Andreo  Cesalpino,  J  the 
Italian  physician  and  naturalist,  was  probably  the 
first  to  suggest  the   methodical  arrangement  of 


*  Nosography,  from  vodo's,  disease,  and  ypdgjeiv,  to  de- 
scribe. 

t  The  works  of  the  ancient  authors,  such  as  Hippocrates, 
Galen,  Celsus,  and  others,  contain  no  synopses  of  classifica- 
tion, but  their  description  of  diseases  is  often  very  accurate 
and- much  of  their  nomenclature  is  still  in  use.  Although  the 
Arabian  physicians  were  close  followers  of  the  doctrines  of 
Aristotle,  nothing  that  can  be  called  a  methodical  classifica- 
tion of  diseases  has  been  found  in  their  treatises. 

\  Cesalpino  was  born  at  Arezzo  in  the  year  15 19  and 
died  in  1603. 


ORIGIN   AND    PROGRESS   OF   NOSOGRAPHY.      75 

diseases.  This  however  was  not  attempted  until 
the  beginning  of  the  seventeenth  century  when, 
in  1602,  Felix  Platerus,  of  Basle,  published,  in  his 
^^  Praxeos  Medicae,''  the  plan  of  a  nosographical 
method,  but  went  no  farther.  Among  other  con- 
tributions were,  the  ''  Nosologia''  of  Warenius  of 
Leipsic,  1605;  the  ^^  Nosologia  Harmonica,  Dog- 
fnatiga,  et  Hermetica''  of  Petraeus  of  Marburg, 
1614;  the  ^^  Idea  Universalis  Medicinae,  of  John- 
stonus  of  Amsterdam,  published  in  1644,  with  a 
section  devoted  to  classification,  wherein  are 
arranged  all  diseases  into  three  classes,  divided 
into  internal  and  external  diseases  ;  and  finally,  in 
1675,  the  '' Nosologia''  of  Schoenfeld.  All  these 
essays  were  incomplete  and  of  little  use  except 
that  they  were  the  forerunners  of  the  good  work 
which  was  subsequentl}^  performed.  Such  was 
the  extent  of  the  progress  of  nosography,  which 
then  stood  still  for  half  a  century.  Sydenham 
and  Baglivius,*  who  wrote  toward  the  end  of 
the  seventeenth  century,  were  of  opinion  that 
diseases  should  be  classified,  like  systems  of 
botany,  by  genera  and  species  with  characteristic 
definitions.  Other  physicians  of  their  time  were 
of  the  same  opinion  (CuUen).     It  appears,   how- 


*  Georgii  Baglivi,   De  Praxi  Medica,  etc.,   Lugduni  Batavo- 
rum,  1700. 


^6     ORIGIN   AND    PROGRESS   OF   NOSOGRAPHY. 

ever,  that  this  was  not  attempted  until  the  year 
1732,  when  Frangois  Boissier  de  Sauvages  of 
Montpellier  published  an  essay  with  the  title  of 
**  Nouvelles  Classes  de  Maladies  Disposees  dans  un 
Ordre  semblable  a  celui  des  Botanistes.''  From  this 
preliminary  essay  he  built  up  his  "  Nosologia 
Methodica'  which  he  did  not  publish  until  1760, 
after  nearly  thirty  years  of  diligent  labor.  Men- 
tion should  also  be  made  of  the  nosographical 
contribution  of  Hebenstreit  of  Leipsic,  1754. 
But  Sauvages  was  really  the  founder  of  method- 
ical nosography  to  which  he  gave  the  greatest 
impulse.  He  was  followed  by  Linnaeus,  Vogel, 
CuUen,  Sagar,  Macbride,  Vitet,  Darwin,  Selle, 
Pinel,  Baumes,  Tourdes,  Tourtelle,  Recamier, 
Crichton,  Parr,  Swediaur,  Young,  Richerand, 
Good,  Alibert,  Hosack,  and  others  who,  in  some 
instances,  subtracted  from,  or  added  to,  without 
materially  changing,  his  great  plan  the  frame- 
work of  which  they  all  retained  while  they  made 
very  little  change  in  his  nomenclature,  much  of 
which  is  still  in  use. 

Sauvages  was  a  man  of  brilliant  mind  and  ex- 
traordinary industry.  He  had  been  prepared  for 
his  task  of  founding  the  science  of  nosography  by 
a  broad  and  liberal  education.  He  had  studied 
and  taught  botany,  and  his  tastes  brought  him 
into  close  relations  with  the  renowned  Linnaeus. 


ORIGIN  AND    PROGRESS   OF  NOSOGRAPHY.      ^J 

He  had  for  counselor  the  illustrious  Boerhaave, 
from  whom  he  received  much  encouragement  in 
the  prosecution  of  his  difficult  and  arduous  la- 
bors. He  cheerfully  accepted,  and  profited  by, 
the  criticisms  of  his  contemporaries,  and  lived  to 
complete,  but  not  to  see  in  print,  the  last  revision 
of  his  gigantic  work  which  was  not  published 
until  a  year  after  his  death.  Sauvages  had  en- 
tered the  medical  profession  at  an  early  age,  and 
had  passed  a  little  over  one  year  in  Paris  where 
he  gathered  the  material  for  an  essay  upon 
fevers.  His  first  nosographical  essay  was  pub- 
lished in  1732.  He  then  wrote  upon  inflamma- 
tion, upon  capillary  vessels,  upon  hemiplegia, 
and  upon  rabies.  He  wrote  also  a  physiological 
conspectus  which  was  published  at  Lyons  in 
1751  ;  upon  a  theory  of  the  circulation  of  the 
blood  ;  upon  the  effects  of  medicaments  ;  upon 
embryology ;  upon  tumors ;  muscular  move- 
ments ;  elements  of  physiology  ;  difficult  respira- 
tion ;  vision ;  a  theory  of  convulsions  ;  method- 
ical pathology  ;  and  finally  came  his  Nosologia 
Methodica.  This  was  the  crowning  work,  for  after- 
wards only  a  few  dissertations  appeared  from  his 
fertile  pen,  and  he  died,  full  of  honors,  on  Febru- 
ary 19th,  1767,  at  the  age  of  sixty-one,  after  an 
illness  of  two  years  duration. 

To   exemplify   the    estimation    in    which  this 


78      ORIGIN   AND    PROGRESS   OF   NOSOGRAPHY. 

truly  great  physician  was  held,  the  following  is 
quoted  from  Good's  Physiological  system  of 
Nosology  1823. 

"  The  Nosologia  Methodica,  for  such  is  the 
title  of  Mr.  de  Sauvages'  work,  is  indeed,  an 
Herculean  labour.  It  consists,  in  its  latest  and 
most  perfect  form,  of  three  distinct  arrangements 
— a  symptomatical,  an  aetiological,  and  an  ana- 
tomical ;  so  as  to  accommodate  itself  to  the  taste 
of  the  old  school  as  well  as  of  the  new.  The 
symptomatical,  to  which  the  others  are  pro- 
fessedly subordinate,  is  by  far  the  most  extens- 
ively elucidated  ;  and  comprises  ten  classes,  (each 
introduced  by  an  elaborate  pathological  synop- 
sis), upwards  of  forty  orders,  more  than  three 
hundred  genera,  and  an  almost  innumerable  host 

of  species We  have  yet,  however,  to  add  the 

varieties,  which  under  several  species  are  not 
few  ;  and  to  bear  in  mind  that  to  every  variety, 
species  and  genus,  as  far  as  their  relative  charac- 
ters will  allow,  are  allotted  a  definition,  list  of 
synonyms,  history,  diagnosis,  prognosis,  and 
mode  of  cure ;  with,  frequently,  an  exemplifica- 
tion of  cases,  and  a  brief  statement  of  the  peculiar 
opinions  of  other  writers,  before  we  can  fairly 
appreciate  the  entire  mass  of  matter  with  which 
the  volumes  of  Mr.  de  Sauvages  abound.  He 
seems,  indeed,  to  have  been  desirous  of  collecting 


ORIGIN  AND   PROGRESS   OF  NOSOGRAPHY.      79 

materials  of  every  kind  and  quality  from  every 
quarter  to  which  a  market  was  open  ;  and  of  fol- 
lowing up  every  deviation  from  health  into  all 
its  possible  as  well  as  its  actual  shades  and  rami- 
fications  " 

The  followers  of  Sauvages,  from  Linnaeus  to 
Hosack  were  all  men  of  much  general  and  scien- 
tific culture.  None  of  these  eminent  men  was 
better  endowed  with  those  requisite  qualities 
than  the  celebrated  Cullen,  who  in  the  edition  of 
his  works  prepared  in  1827  by  Doctor  John 
Thomson,  paraphrases  an  aphorism  of  the  illus- 
trious Aristotle  as  follows : 

"  Perfect  division  and  definition  is  the  summit 
of  human  knowledge  in  every  part  of  science, 
and  requires  not  only  the  clearest  but  the  most 
comprehensive  views,  such  as,  with  respect  to 
diseases,  we  can  arrive  at  only  by  often-repeated 
exercises  and  much  study." 

Cullen  further  says,  "  The  attempt  may  at  first 
appear  uncouth  and  difficult,  but  by  repetition  it 
will  become  more  familiar  and  easy,  and  3"ou 
must  be  content  to  make  such  a  progress.  When 
a  little  more  than  thirty  years  ago,  I  first  got  a 
sight  of  the  botanical  system  of  Linnaeus,  it  ap- 
peared to  me  to  be  a  piece  of  the  most  uncouth 
jargon  and  minute  pedantry ;  but,  by  length  of 
time,  it  is  now  as  familiar  to  me  as  my  mother 


8o  A   CONSENSE   OF   VIEWS   NECESSARY 

tongue ;  and  with  whatever  difficulty  it  was  first 
received  in  most  parts  of  Europe,  it  has  now  sur- 
mounted these,  and  its  utility  has  reconciled 
every  person  to  the  study  of  it." 


A   CONSENSE    OF   VIEWS    NECESSARY    IN 
METHODICAL  ARRANGEMENT. 

The  earliest  medical  authors  realised  the  im- 
portance of  arrangement*  in  the  elucidation  of 
their  teachings,  but  formed  no  concerted  plan. 
The  effect  of  this  lack  of  common  agreement  was 
the  adoption  of  many  differing  methods.  Most 
of  these  early  writers  divided  their  works  into 
parts,  books,  chapters,  and  sections.  Some  of 
them  adopted  the  synoptic,  and  others  the  sys- 
tematic method.  Later  the  method  of  the  bota- 
nists was  adopted ;  and  the  arrangement  of  dis- 
eases into  classes,  orders,  genera  and  species,  has, 
ever  since,  been  used  by  the  systematic  writers. 
The  systematic  method  has  been  variously  modi- 
fied :  (i,)  by  the  adoption  of  an  alphabetical  ar- 
rangement of  diseases  ;  (2,)  by  the   arrangement 


*  "  Without  arrangement,  no  art  or  science  can  be  acquired, 
for  in  its  absence  none  can  be  treated  of  or  communicated." 
(J.  M.  Good.) 


IN    METHODICAL  ARRANGEMENT.  8 1 

of  diseases,  in  accordance  with  their  duration, 
into  acute  and  chronic  diseases ;  (3,)  by  the 
arrangement  of  diseases  in  accordance  with  the 
anatomical  regions  of  the  body,  such  as  the 
head,  the  trunk,  and  the  extremities ;  (4,)  by  the 
arrangement  of  diseases  in  accordance  with  their 
aetiology ;  (5,)  by  the  arrangement  of  dis- 
eases in  accordance  w^ith  the  sex  and  age  of  the 
patients ;  and  (6,)  by  the  arrangement  of  dis- 
eases in  accordance  with  their  symptoms.  The 
last  named  arrangement  having  been  suggested 
by  Platerus  and  first  effected  by  Sauvages. 
In  order  to  convey  to  the  mind  a  correct  idea 
of  the  arrangement  adopted  by  the  nosographers 
of  the  past,  a  synopsis  of  the  classes  of  the  most 
prominent  among  them  is  introduced.  But  the 
synopses  of  Sauvages,  CuUen,  Parr,  Good,  and 
Delorme,  are  given  entire  to  enable  the  student 
to  conveniently  examine  and  compare  these 
several  systems.  Sauvages'  system  (i 732-1 767), 
representing  the  beginning  of  the  science ;  Cul- 
len's  system  (i  769-1 790),  showing  the  progress 
made  up  to  his  time  ;  Parr's  system  (1809),  ex- 
hibiting a  marked  change,  not  however  for  the 
better,  in  classification,  while  the  nomenclature  is 
little  changed ;  Good's  system  (1822),  showing  a 
very  great  improvement  in  classification  though 
not  in  nomenclature ;  and  Raige-Delorme's  sys- 


82      NOMENCLATURE  OF  HIPPOCRATES. 

sytem  (1841),  being   a  fair   specimen  of  the  de- 
cline of  nosographj  in  France. 

As  it  may  be  useful  to  students  of  nosography 
to  have  before  them  some  ol  the  most  ancient 
terms  used  in  medicine,  a  part  of  the  nomen- 
clature of  Hippocrates  is  here  inserted  in  order 
that  they  may  see  at  a  glance  those  ancient  words 
which  are  retained  in  the  existing  medical  nomen- 
clature. 

ALPHABETICAL  LIST  OF  DISEASES  UPON  WHICH 

HIPPOCRATES  HAS  WRITTEN,  BEING  A  FAIR 

EXEMPLIFICATION   OF   HIS 

NOMENCLATURE.* 

1  Abscesses 

2  Achores 

3  Alopecia 

4  Anasarca 

5  Anchylosis 

6  Anus,  inflamed 

7  "       hard  tubercles  of  or  near  the 

8  Appetite,  canine 

9  "       ,  loss  of 


*  From    Motherby's    Medical    Dictionary.     Third    edition, 
London.  1791. 


NOMENCLATURE  OF  HIPPOCRATES.     83 

10  Aphthae 

11  Apolepsis 

12  Apoplexy 

13  Arms,  shortness  of  the 

14  Ascarides 

15  Asthma 

16  Auante 

17  Baldness 

18  Barrenness 

19  Biles 

20  Bladder,  tubercles  in  the 

21  Blood,  spitting  of 

22  "     ,  vomiting 

23  Blotches,   red  on  the  legs,   from   sitting  by 

the  fire 

24  Brain,  concussion  of  the 

25  ''     ,  ruptured  vessels  in  the 

26  Breath,  foetid 

27  '*      ,  straightness  of  the 

28  Buboes 

29  Carbuncle 

30  Catamenia :  disordered,  natural 

31  Catoche 

32  Cancers 

33  Carus 

34  Cataphora 

35  Cachexy 

36  Catarrh 


84  NOMENCLATURE  OF   HIPPOCRATES. 

37  Caries 

38  Cheek,  a  sphacelous  of  the 

39  Chilblains 

40  Cholera  morbus 

41  Chalk  stones  in  the  joints 

42  Cough 

43  Coryza 

44  Coma 

45  *'      vigil 

46  Contractions  of  the  fibres 

47  Consumption,  of  the  whole  body 

48  '*  ,  ischiadic 

49  *'  ,  nephritic 

50  Colour,  bad 

51  Crookedness 

52  Deafness 

53  Delirium 

54  Defluxion  or  rheum 

55  Diarrhoea 

56  Dreams,  frightful 

57  Dumbness 

58  Dysentery 

59  Dyspnoea 

60  Dysury 

61  Ears,  pains  in  the 

62  "    ,  redundant  moisture  in  the 

63  "    ,  ringing  in  the 

64  "   ,  tubercles  about  the 


NOMENCLATURE   OF   HIPPOCRATES.  8$ 

65  Ecchymosis  from  contusion 

66  Empyema 

6y  Emprosthotonos 

68  Epilepsy 

69  "         ,  in  children 

70  Epinyctides 

71  Erysipelas 

72  Eruption  on  the  skin 

73  Evil 

74  Eye,  distortion  of  the 

75  "  ,  bleared 

y6  ''  ,  dry-bleared 

yy  "  ,  clouds  in  the 

78  "  ,  cicatrices  in  the 

79  "■  ,  pearls  in  the 

80  '*  ,  white  spots  in  the 

81  *'  ,  ruptured 
S2  "  ,  exulcerated 

83  "  ,  inflamed 

84  ''  ,  dry  inflammation  of  the 

85  Eye-lids,  excressences  on  the 

86  "        ,  tumid  outward 
-87         "       ,  coalesence  of  the 
B8         ''        ,  scabby 

Sg        "       J  tumors  on  the 

90  Face,  hard  tubercles  on  the 

91  Favi 

92  Fainting 


86     NOMENCLATURE  OF  HIPPOCRATES. 

93  Fevers 

94  Fistulas 

95  Fractures 

96  Freckles 

97  Gangrene 

98  Glaucoma 

99  Green  sickness 

00  Griping  of  the  intestines 

01  Gout 

02  Gonorrhoea  benigna 

03  Gums,  black 

04  ''      ,  pains  in  the,  from  teething 

05  "      ,  tubercles  on  the 

06  Haemorrhages 

07  Haemorrhoids 

08  Hearing,  dull 

09  Heartburn 

10  Head,  heaviness  of  the 

11  "     ,  ache 

12  '^     ,  scurvy 

13  Herpes 

14  Hesitation 

15  Hiccough 

16  Horror 

17  Hoarseness 

18  Humors,  discharge  of  morbid 

19  Hysterics 

20  Hypersarcosis 


NOMENCLATURE   OF   HIPPOCRATES.  8/ 

121  Jaundice 

122  Illiac  passion 

123  Impotence 

124  Inflammation:  external,  internal 

125  Itch 

126  Itching 

127  ''      ,  a  pungent,  in  the  mouth 

128  Kidnies,  disorders  of  the 

129  Labour,  difficult 

130  Leprosy 

131  "        ,  the  white 

132  Lethargy 

133  Leucophlegmatia 

134  Lientery 

135  Lips,  fissures  in  the 

136  Limping 

137  Liver,  inflamed 

138  Lochia,  disordered 

139  Lungs,  spasmodically  contracted 

140  ''      ,  varix  in  the 

141  "      ,  suppurated 

142  "      ,  crude  tubercles  in  the 

143  Luxations 

144  Madness 

145  Melancholy 

146  Mind,  alienation  of  the 

147  "     ,  alienation  through  melancholy 

148  Miscarriage 


88     NOMENCLATURE  OF  HIPPOCRATES. 

149  Mole 

150  Mouth,  distorted 

151  Nauseating  food 

152  Navel,  inflamed 

153  Neck,  a  hard  tumor  in  the 

154  Nose,  a  discharge  of  pus  in  the 

155  Nocturnal  pollutions 

156  Nyctalops 

157  Opisthotonos 

158  Orthopnea 

159  Pain,  in  the  loins 

160  Palpitation 

161  Peripneumony 

162  Phlj'ctaenae 

163  Phrenitis 

164  Phrontis 

165  Placenta,  adhering 

166  Plague 

167  Pleurisy 

168  "        ,  a  dry 

169  "        ,  a  moist 

170  Polypus,  in  the  nose 

171  Pterygion 

172  Pustules,  from  acrid  sweat 

173  Pudenda,  excressences  of  the 

174  "       ,  putrefaction  of  the 

175  Pupil  of  the  eye,  too  small  or  angular 

176  ''      "      "      "  ,  exulcerated 


NOMENCLATURE   OF   HIPPOCRATES.  89 

177  Pupil  of  the  eye,  cicatrix  of  the 

178  "      *'      "      ''  ,  spoiled 

179  '*      "      '*      "  ,  removed  from   its   natural 

situation 
i8o       *'      "      **      "  ,  prominent 

181  Quinsey,  affecting  the  lungs 

182  Restlessness 

183  Rheum,  a  defluxion  of 

184  Ruptures 

185  Salivation,  a  spontaneous 

186  Sciatica 

187  Scurvy 

188  Sensation,  suddenly  lost 

189  Shivering 

190  Sight,  a  privation  of 

191  Skin,  desquamations  of  the 

192  Speech,  too  volatile 

193  Spleen,  swelled 

194  **     ,  inflamed 

195  Spine,  distorted  forwards 

196  Sprains 

197  Sphacelus 

198  Stertor 

199  Strangury 
:2oo  Stone 

201  Stupidity 

202  Stammering 

203  Superfetation 


90  NOMENCLATURE   OF   HIPPOCRATES. 

204  Tabes  dorsalis 

205  Teeth,  stupor  of  the 

206  "      ,  gnashing  and  grinding  of  the 

207  "      ,  ache 

208  "      ,  of  both  jaws  fixed  together 

209  Tetanus 

210  Tetters 

211  Testicles,  swelled 

212  Tenesmus 

213  Terminthi 

214  Tonsils,  disorders  of  the 

215  "      ,  swelled 

216  Torpidness  of  the  body 

217  Tongue,  fissured 

218  "       ,  tumor  under  the 

219  Trichosis 

220  Tubercles  of  various  sorts 

221  Tumors 

222  Uvula,  relaxed 

223  "     ,  retracted 

224  "     ,  putrefied 

225  Uterus,  disorders  of  the 

226  "      ,  fallmg  down  of  the 

227  Ulcers 

228  Urine,  retained 

229  Urethra,  caruncles  or  tubercles  in  the 

230  Voice,  loss  of  the 

231  Varices 


SAUVAGES'    SYSTEM.  9I 


232  Vertigo 

233  Warts 

234  Worms 

235  Whitlow 

236  Wry  neck 

237  Wounds 

238  White  flux 
339  Yawning 


SYNOPSIS   OF  THE   CLASSES,    ORDERS,   AND 
GENERA   OF    SAUVAGES'   SYSTEM. 

CLASSIS  1.     VITIA. 
Ordo  I.     Maculae. 

Genus  i.  Leucoma. 

2.  Vitiligo. 

3.  Ephelis. 

4.  Gutta  rosea. 

5.  Naevus. 

6.  Ecchymoma. 

Ordo  II.     Efflorescentiae. 

Genus  7.  Herpes. 

"       8.  Epinyctis. 

"       9.  Psydracia. 

''     10.  Hidroa. 


92 

SYNOPSIS   OF 

Ordo  III.     Phymata. 

Genus 

II. 

Erythema. 

n 

12. 

Oedema. 

ti 

13. 

Emphysema. 

il 

14. 

Scirrhus. 

<( 

15. 

Phlegmone. 

« 

16. 

Bubo. 

(< 

17. 

Parotis. 

il 

18. 

Furunculus. 

fi 

19. 

Anthrax. 

it 

20. 

Cancer. 

n 

21. 

Paronychia. 

tl 

22. 

Phimosis. 
Ordo  IV.    Excrescenti 

Genus 

23. 

Sarcoma. 

<< 

24. 

Condyloma. 

(( 

25. 

Verruca. 

<( 

26. 

Pterygium. 

11 

27. 

Hordeolum. 

a 

28. 

Bronchocele. 

<< 

29. 

Exostosis. 

(( 

30. 

Gibbositas. 

(( 

31- 

Lordosis. 

Ordo  V.     Cystides. 


Genus  32.     Aneurysma. 
"       33.     Varix. 


SAUVAGES*    SYSTEM.  93 


Genus 

34. 

Hydatis. 

<( 

35. 

Marisca. 

(( 

36. 

Staphyloma. 

<( 

37- 

Lupia. 

<< 

38. 

Hydrarthrus. 

it 

39- 

Apostema. 

it 

40. 

Exomphalus. 

(( 

41. 

Oscheocele. 

OrDO    VI.      ECTOPIAE 

Genus 

42. 

Exophthalmia. 

<< 

43. 

Blepharoptosis. 

<i 

44- 

Hypostophyle. 

(( 

45. 

Para^lossa. 

<( 

46. 

Proptoma. 

(( 

47. 

Exania. 

<( 

48. 

Exocyste. 

<< 

49. 

Hysteroptosis. 

<< 

50. 

Enterocele. 

<( 

51- 

Epiplocele. 

(< 

52. 

Gasterocele. 

(< 

53. 

Hepatocele. 

<( 

54. 

Splenocele 

(( 

55. 

Hysterocele. 

(( 

56. 

Cystocele. 

(( 

57. 

Encephalocele. 

<( 

58. 

Hysteroloxia. 

<( 

59- 

Parorchydium. 

94 


SYNOPSIS   OF 


Genus  60. 

Exarthrema. 

"       61. 

Diastasis. 

"      62. 

Laxarthrus. 

Ordo  VII 

Genus  63. 

Vulnus. 

'       64. 

Punctura. 

'       65. 

Excoriatio. 

*       66. 

Contusio. 

'       67. 

Fractura. 

*       68. 

Fissura. 

'       69. 

Ruptura. 

'       70. 

Amputatura. 

'      71- 

Ulcus. 

*      72. 

Exulceratio. 

'       73. 

Sinus. 

'       74. 

Fistula. 

'       75. 

Rhagas. 

'      76. 

Eschara. 

'      77- 

Caries. 

'      78. 

Arthrocace. 

CLASSIS  II.     FEBRES. 

Ordo  I.    Continuae. 


Genus  79,     Ephemera. 
"       80.     Synocha. 
"       81.     Synochus. 


SAUVAGES     SYSTEM. 


95 


Genus  82.     Typhus. 
83.     Hectica. 


Ordo  II.     Remittentes. 


Genus  84.     Amphimerina. 
"       85.     Tritaeophya. 
"       86.     Tetartophya. 


Ordo  III.    Intermittentes. 


Genus  87.  Quotidiana. 

"       88.  Tertiana. 

"       89.  Quartana. 

"      90.  Erratica. 


CLASSIS  III.     PHLEGMASIAE. 
Ordo  I.    Exanthematicae. 


Geuus 

91, 

Pestis. 

92. 

Variola. 

93- 

Pemphigus 

94. 

Rubeola. 

95. 

Miliaris. 

96. 

Purpura. 

97- 

Erysipelas. 

98. 

Scarlatina. 

99. 

Effera. 

100 

Aphtha. 

96 

SYNOPSIS 

OF 

( 

Ordo  II.    Membranaceae. 

Genus 

lOI. 

Phrenitis. 

it 

I02. 

Paraphrenesis. 

It 

103. 

Pleuritis. 

11 

104. 

Gastritis. 

u 

105. 

Enteritis. 

n 

106. 

Epiploitis. 

u 

107. 

Metritis. 

n 

108. 

Cystitis. 

Ordo  III.    Parenchymatosae, 

Genus 

109. 

Cephalitis. 

it 

no. 

Cynanche. 

it 

III. 

Carditis. 

tt 

112. 

Peripneumonia, 

tt 

113. 

Hepatitis. 

tt 

114. 

Splenitis. 

tt 

115. 

Nephritis. 

CLASSIS  IV. 

SPASMI. 

Ordo  I.    Tonici 

Partiales. 

Genus 

116. 

Strabismus. 

i< 

117. 

Trismus. 

tt 

118. 

Obstipitas. 

tt 

119. 

Contractura. 

tt 

120. 

Crampus. 

tt 

121. 

Priapismus. 

SAUVAGES'    SYSTEM.  97 


0\ 

RDO  II.    ToNci  Generales. 

Genus 

122. 

Tetanus. 

it 

123. 

Catochus. 

Ordo  III.    Clonici  Partiales. 

Genus 

124. 

N3^stagmus. 

125. 

Carphologia. 

126. 

Pandiculatio. 

127. 

Apomyttosis. 

128. 

Convulsio. 

129. 

Tremor. 

130. 

Palpitatio. 

131. 

Claudicatio. 

Ordo  IV.    Clonici  Generales 

Genus 

132. 

Rigor. 

133. 

Eclampsia. 

134. 

Epilepsia. 

135. 

Hysteria. 

136. 

Scelotyrbe. 

137. 

Beriberia. 

CLASSIS  V.     ANHELATIONES. 
Ordo  I.    Spasmodicae. 


Genus  138. 

Ephialtes. 

"       139. 

Sternutatio. 

140. 

Oscedo. 

98 

SYNOPSIS   OF 

Genus 

141. 

Singultus. 

<( 

142. 

Tuffis. 

Ordo  II.    Oppressivae 

Genus 

143. 

Stertor. 

<( 

144. 

Dyspnoea. 

<( 

145. 

Asthma. 

u 

146. 

Orthopnoea. 

<< 

147. 

Angina. 

(<    > 

148. 

Pleurodyne. 

(( 

149. 

Rheuma. 

a 

150. 

Hydrothorax. 

151.     Empyema. 


CLASSIS  VI.     DEBILITATES. 

Ordo  I.     Dysaesthesiae. 

Genus  152.  Cataracta. 

"  153.  Caligo. 

"  154.  Amblyopia 

"  155.  Amaurosis. 

*'  156.  Anosmia. 

"  157.  Agheustia. 

"  158.  Dysecoea. 

«  159-  Paracusis. 

"  160.  Cophosis. 

"  161.  Anaesthesia. 


SAUVAGES     SYSTEM. 


99 


Ordo  II.    Anepithymiae. 

Genus  162.     Anorexia. 
Adipsia. 
Anaphrodisia. 

Ordo  III.    Dyscinesiae. 

Genus  16^.     Mutitas. 
Aphonia. 
Psellismus. 
Paraphonia. 
Paralysis. 
Hemiplegia. 
Paraplegia. 

Ordo  IV.    Leipopsychiae. 

Genus  172.     Asthenia. 

Leipothemia. 

Syncope. 

Asphyxia. 

Ordo  V.     Comata. 


163. 
164. 


165 
166 
167 
168 
169 
170 
171 


172. 

173- 
174. 

175. 


Genus  176.  Catalepsis. 

177.  Ecstasis. 

178.  Typhomania. 

179.  Lethargus. 

180.  Cataphora. 

181.  Carus. 
182.-  Apoplexia. 


lOO 


SYNOPSIS   OF 


CLASSIS  VII.     DOLORES. 


Ordo  I.     Vagi 

Geuus 

183. 

Arthritis. 

u 

184. 

Ostocopus. 

l( 

185. 

Rheumatismus. 

<< 

186. 

Catarrh  us. 

n 

187. 

Anxietas. 

<( 

188. 

Lassitudo. 

<( 

189. 

Stupor. 

a 

190. 

Pruritus. 

(( 

191. 

Algor.                  ' 

(( 

192. 

Ardor. 
Ordo  II.    Capit 

Genus 

193. 

Cephalalgia. 

<i 

194. 

Cephalaea. 

n 

195. 

Hemicrania. 

11 

196. 

Ophthalmia. 

il 

197. 

Otalgia. 

(( 

198. 

Odontalgia. 

Ordo  III.    Pectoris. 


Genus  199.     Dysphagia. 
"       200.     Pyrosis. 
"       201.     Cardiogmus. 


SAUVAGES     SYSTEM.  lOI 


Ordo  IV.     Abdominales  internl 

Genus  202. 

Cardialgia. 

"      203. 

Gastrodynia. 

"      204. 

Collca. 

**      205. 

Hepatalgia. 

"      206. 

Splenalgia. 

"      207. 

Nephralgia. 

"      208. 

Dystocia. 

"      209. 

Hysteralgia. 

Ordo  V.    Externi  et  artuum. 

Genus  210. 

Mastodynia. 

"      211. 

Rhachialgia. 

"      212. 

Lumbago. 

"      213. 

Ischias. 

"      214. 

Proctalgia. 

"       215. 

Pudendagra. 

CLASSIS  VIII.     VESANIAE. 

Ordo  I.     Hallucinationes. 

Genus  216.  Vertigo. 

"       217.  Sujfifusio. 

**       218.  Diplopia. 

"       219.  Syrogmos. 

**       220.  Hypochondriasis. 

"       221.  Somnambulismus. 


102 

SYNOPSIS   OF 

Ordo  II.    Morositates. 

Genus  222. 

Pica. 

''       223. 

Bulimia. 

"       224. 

Polydipsia. 

''       225. 

Antipathia. 

"       226. 

Nostalgia. 

"       227. 

Panophobia. 

228. 

Satyriasis. 

"       229. 

Nymphomania. 

"       230. 

Tarantismus. 

''       231. 

Hydrophobia. 

Ordo  III.     Deliria. 

Genus  232. 

Paraphrosyne. 

"       233. 

Amentia. 

''       234. 

Melancholia. 

"       235. 

Mania. 

236. 

Demonomania. 

Ordo  IV.     Vesaniae  anomalae 

Genus  237. 

Amnesia. 

"      238. 

Agrypnia. 

CLASSIS  IX.     FLUXUS. 
Ordo  I.     Sangninfluxus. 


Genus  239.     Haemorrhagia. 
"       240.     Haemoptysis. 


SAUVAGES     SYSTEM.  IO3 


Genus  241.  Stomacace. 

"       242.  Haematemesis. 

**       243.  Haematuria. 

"       244.  Menorrhagia. 

**       245.  Abortus. 


Ordo  II.    Alvifluxus. 


Genus  246.  Heptirrhoea. 

"  247.  Haemorrhois. 

'*  248.  Dysenteria. 

"  249.  Melaena. 

"  250.  Nausea. 

"  251.  Vomitus. 

**  252.  Ileus. 

"  253.  Cholera. 

"  254.  Diarrhoea. 

"  255.  Caeliaca. 

''  256.  Lienteria. 

"  257.  Tenesmus. 


Ordo  III.     Serifluxus. 


Genus  258.  Ephidrosis. 

259.  Epiphora. 

260.  Coryza. 

261.  Ptyalismus. 

262.  Anacatharsis 

263.  Diabetes. 

264.  Enuresis. 


104  SYNOPSIS   OF 

Genus  265.  Dysuria. 

266.  Pyuria. 

267.  Leucorrhoea. 

268.  Gonorrhoea. 

269.  Dyspermatismus. 

270.  Galactirrhoea. 

271.  Otorrhoea. 

OrDO    IV.      ACRIFLUXUS. 

Genus  272.     Flatulenta. 
"       273.     Aedopsophia. 
"       274.     Dysodia. 

CLASSIS  X.    CACHEXIAE. 
Ordo  I.    Macies. 

Genus  275.  Tabes. 

"       276.  Phthisis. 

"       277.  Atrophia. 

"       278.  Aridura. 

Ordo  II.     Intumescentiae. 

Genus  279.  Polysarcia. 

"       280.  Pneumatosis. 

"       281.  Anasarca. 

"       282.  Phlegmatia. 

*'       283.  Physconia. 

"       284.  Graviditas. 


SAUVAGES    SYSTEM. 


105 


Ordo  III.     Hydropes  Partiales. 


Genus  285. 

Hydrocephalus. 

•'       286. 

Physocephalus. 

"       287. 

Hydrorhachitis. 

"       288. 

Ascites. 

"       289. 

Hydrometra. 

"       290. 

Physometra. 

"       291. 

Tympanites. 

"       292. 

Meteorismus. 

*•       293. 

Ischuria. 

Ordo  IV.    Tubera. 

Genus  294. 

Rhachitis. 

"       295. 

Scrophula. 

**       296. 

Carcinoma. 

"       297. 

Leontiasis. 

"       298. 

Malis. 

"       299. 

Framboesia. 

- 

Ordo  V.    Impetigines 

Genus  300. 

SyphiHs. 

"       301. 

Scorbutus. 

302. 

Elephantiasis. 

"       303. 

Lepra. 

"       304. 

Scabies. 

•*       305. 

Tinea. 

io6 

COMMENTS    ON 

Ordo  VI.     Icteritiae. 

Genus  306. 

Aurigo. 

''       307. 

Melasicterus. 

"       308. 

Phaenigmus. 

309. 

Chlorosis. 

Ordo 

1  VII.     Cachexiae  ano 

Genus  310. 

Phthiriasis. 

"       311. 

Trichoma. 

"       312. 

Alopecia. 

"       313- 

Elcosis. 

*'       314. 

Gangraena. 

"       315. 

Necrosis. 

In  his  nosologia  methodica,  Sauvages  enumerates 
ten  classes,  forty-four  orders,  three  hundred  and 
fifteen  genera  and  many  species  and  varieties. 

Many  of  the  orders  contain  genera  that  bear 
no  relation  with  each  other.  For  instance  in  the 
third  order,  phyrnata,  of  the  first  class,  vitia,  are 
included  erythema,  emphysema,  scirrhus,  bubo, 
anthrax,  cancer,  paronychia  and  phimosis.  In 
the  fourth  order  excrescentiae,  are  placed  sarcoma, 
condyloma,  pterygium,  bronchocele,  and  exos- 
tosis. In  the  fifth  order  cystidcs  are,  aneurysm, 
varix,  marisca  (piles),  staphyloma,  hydrarthrus, 
and  oscheocele. 

In  the  second  class  are  arranged  the  fevers,  in 


SAUVAGES'    SYSTEM.  10/ 

three  orders,  continued,  remittent,   and  intermit- 
tent, and  twelve  genera. 

In  the  first  order  exanthematicae^  of  the  third 
c\2iS?,, phleginasiae,  are  placed  the  plague,  small  pox, 
measles,  purpura,  erysipelas,  and  aphtha.  In  the 
second  order  membranaceae,  are  phrenitis,  pleuri- 
tis,  gastritis,  metritis,  and  cystitis.  In  the  third 
order,  parenchymatosae ,  are  cephalitis,  carditis, 
nephritis,  etc. 

There  are  many  other  defects  in  this  system 
which  now  make  it  of  little  use,  but  it  should  be 
borne  in  mind  that  medicine  has  greatly  ad- 
vanced since  the  time  of  Sauvages,  and  that  his 
classification  is  one  of  the  great  factors  in  this 
advance.  He  used,  to  the  best  advantage,  the 
knowledge  and  the  material  which  he  possessed, 
and  his  system  made  a  profound  impression  on 
the  profession. 

Sauvages  had  an  enthusiastic  admirer  in  Lin- 
naeus who,  after  following  the  Sauvagian  system, 
for  nearly  twent}^  years,  in  his  lectures  at  Upsala, 
caused  to  be  published  (in  1759),  a  classification 
of  diseases  prepared,  under  his  direction,  by  one 
of  his  disciples.  Afterwards  he,  himself,  pre- 
pared and  published  (in  1763),  a  new  classifica- 
tion of  diseases  very  similar  to  that  of  Sauvages 
and  consisting  of  eleven  classes:  i,  Exanthema- 
tici ;    2,  Critici;    3,  Phlogistici ;    4,  Dolorosi ;     5, 


I08  LINNAEUS,    VOGEL. 

Mentales ;  6,  Quietales ;  7,  Motorii ;  8,  Sup- 
pressorii ;  9,  Evacuatorii ;  10,  Deformes ;  11, 
Vitia:  thirty-seven  orders,  and  three  hundred 
and  twenty-six  genera. 

In  comparing  this  nosographical  table  with 
that  of  Sauvages,  says  Pinel,  it  is  easily  seen 
that  descriptive  medicine  had  not  made  great 
progress  under  the  fertile  pen  of  Linnaeus. 

Linnaeus  was  soon  followed  by  Vogel  of  Got- 
tingen  who,  (in  1764),  published  a  classification  of 
diseases  consisting  of  eleven  classes  :  i,  Febres  ; 
2,  Profluvia  ;  3,  Epischeses ;  4,  Dolores ;  5, 
Spasmi ;  6,  Adynamiae  ;  7,  Hyperaestheses  ; 
8,  Cachaexiae ;  9,  Paranoiac;  10,  Vitia;  11, 
Deformitates,  and  five  hundred  and  sixty  genera. 

Vogel  introduces  three  new  classes  :  (3,)  Epis- 
cheses, (6,)  Adynamiae,  and  (7,)  Hyperaestheses ; 
and  places  phlegmasiae  among  the  vices. 

The  nosology  of  Cullen  was  first  published  in 
1769,  and  was  followed  by  several  revisions.  It 
contains  four  classes,  nineteen  orders,  one  hun- 
dred and  fifty  genera,  nearly  six  hundred  species, 
and  many  varieties.  A  synopsis  of  the  classes, 
orders,  and  genera,  is  here  introduced  for  com- 
parison with  the  preceding  systems. 


cullen's  synopsis.  109 

cullen's  synopsis  of  classes,  orders  and 

genera  of  diseases.    partly  from 

the  edition  of  1 827. 

CLASSIS  1.     PYREXIAE. 

Ordo  I.     Febres. 

Sectio  I.     Interniittentes. 
Genus  i.     Tertiana. 
"       2.     Ouartana. 
"       3.     Quotidiana. 

Sectio  2.     Continuae. 
Gemis  4.     Synocha. 
'*       5.     Typhus. 
"       6.     Synochus. — Hectica. 

Ordo  II.    Phlegmasiae. 

Genus  7.  Phlogosis — Apostema. 
Gangrena — Sphacelus. 

8.  Ophthalmia. 

'*       9.  Phrenitis. 

"     10.  Cynanche. 

'^     II.  Pneumonia. — Vomica.     Empyema. 

"     12.  Carditis. 

"     13.  Peritonitis. 

*'     14.  Gastritis. 

*'     15.  Enteritis. 

**     16.  Hepatitis. 


no  CULLEN  S   SYNOPSIS. 

Genus  17.  Splenitis. 

"       18.  Nephritis. 

"       19.  Cystitis. 

"       20.  Hysteritis. 

"       21.  Rheumatismus — Arthrodynia. 

"       22.  Odontalgia. 

"       23.  Podagra. 

"       24.  Arthropuosis. 

Ordo  III.    Exanthemata. 

Genus  25.  Variola. 

*'       26.  Varicella. 

**       27.  Rubeola. 

*'       28.  Scarlatina. 

"       29.  Pestis. 

"       30.  Erysipelas. 

"       31.  Miliaria. 

.   "       32.  Urticaria. 

"       33.  Pemphigus. 

"       34.  Aphtha. 

Ordo  IV.    Haemorrhagiae. 

Genus  35.  Epistaxis. 

"       36.  Haemoptisis.     Phthisis. 

"       37.  Haemorrhois. 

"       38.  Menorrhagia. 

"       39.  Catarrhus. 

"       40.  Dysenteria. 


cullen's  synopsis. 


Ill 


CLASSIS  II.     NEUROSES. 


OrDO    I.      COMATA. 

Genus 

41. 

Apoplexia. 

n 

42. 

Paralysis. — Tremor. 
Ordo  II.    Adynamiae, 

Genus 

43. 

Syncope. 

<t 

44. 

Dyspepsia. 

<( 

45. 

Hypochondriasis. 

(< 

46. 

Chlorosis. 

Ordo  III.     Spasmi. 

Genus 

47- 

Tetanus. 

n 

48. 

Trismus. 

n 

49. 

Convulsio. 

<< 

50. 

Chorea. 

<( 

51. 

Raphania. 

<< 

52. 

Epilepsia. 

<( 

53. 

Palpitatio. 

<( 

54. 

Asthma. 

il 

55. 

Dyspnoea. 

i< 

56. 

Pertussis. 

<( 

57. 

Pyrosis. 

<< 

58. 

Colica. 

<( 

59- 

Cholera. 

it 

60. 

Diarrhoea. 

li 

61. 

Diabetes. 

112  CULLEN  S    SYNOPSIS. 

Genus  62.     Hysteria. 
"       63.     Hydrophobia. 

Ordo  IV.     Vesaniae. 

Genus  64.     Amentia. 

65.  Melancholia. 

66.  Mania. 

"       67.     Oneirodynia. 

CLASSIS  III.     CACHEXIAE. 

Ordo  I.     Marcores. 

Genus  6%,     Tabes. 
"       69.     Atrophia. 

Ordo  II.    Intumescentiae. 

Sect  10  /.     Adiposae. 
Genus  70.     Polysarcia. 

Sectio  2.     Flatuosae, 

Genus  71.     Pneumatosis. 
"       72.     Tympanites. 
"       73.     Physometra. 


Sectio  J.     Aquosae, 

Genus  74.     Anasarca. 
"       75.     Hydrocephalus. 
"       ^6,     Hydrorachitis. 


cullen's  synopsis. 


113 


Genus  jy. 

Hydrothorax. 

78. 

Ascites. 

-       79. 

Hvdrometra. 

''       80. 

Hydrocele. 

Seetio  ^.     Solidae. 

Genus  81. 

Physconia. 

82. 

Rachitis. 

Ordo  III.     Impetigines 

Genus  83. 

Scrophula. 

"       84. 

Syphilis. 

-       85. 

Scorbutus. 

-       86. 

Elephantiasis. 

"       87. 

Lepra. 

''       88. 

Frambesia. 

"       89. 

Trichoma. 

-       90. 

Icterus. 

CLASSIS  IV.     LOCALES. 

Ordo  I.    Dysaesthesiae. 


mus  91. 

Caligo. 

"       92. 

Amaurosis. 

"       93- 

Dysopia. 

"       94. 

Pseudoblepsis. 

"       95. 

Dysecoea. 

-       96. 

Paracusis. 

114 


cullen's  synopsis. 


Genus  97.     Anosmia. 
"       98.     Agheustia. 
"       99.     Anaesthesia. 

Ordo  II.    Dysorexiae. 
Sectio  I.     Appetitus  Erronei. 
Genus  100.     Bulimia. 


il 

lOI. 

Polydipsia. 

l( 

102. 

Pica. 

(( 

103. 

Satyriasis. 

(< 

104. 

Nymphomania. 

<( 

105. 

Nostalgia. 

Sectio  2.     Appetitus  deficiens 

Genus 

106. 

Anorexia. 

<( 

107. 

Adipsia. 

i( 

108. 

Anaphrodisia. 
Ordo  III.    Dyscinesiae. 

Genus 

109. 

Aphonia. 

<< 

no. 

Mutitas. 

<< 

III. 

Paraphonia. 

<< 

112. 

Psellismus. 

<< 

113- 

Strabismus. 

<( 

114. 

Dysphagia. 

(< 

115. 

Contractura. 

cullen's  synopsis. 


115 


Ordo  IV.    Apocenoses 

Genus 

116. 

Profusio. 

117. 

Ephidrosis. 

118. 

Epiphora. 

119. 

Ptyalismus. 

120. 

Enuresis. 

121. 

Gonorrhoea. 

Ordo  V.     Epischeses. 

Genus 

122 

Obstipatio. 

n 

123. 

Ischuria. 

n 

124. 

Dysuria. 

tl 

125. 

Dyspermatismus. 

It 

126. 

Amenorrhoea. 

Ordo  VI.    Tumores. 

Genus 

127 

Aneurysma. 

128. 

Varix. 

129. 

Ecchymoma. 

" 

130. 

Scirrhus. 

131- 

Cancer. 

132. 

Bubo. 

133- 

Sarcoma. 

134. 

Verruca. 

135. 

Clavus. 

136. 

Lupia. 

137- 

Ganglion. 

Il6 

SAG^ 

lR. 

Genus 

138. 

Hydatis. 

<< 

139- 

Hydrarthrus 

(< 

140. 

Exostosis. 

Ordo  VII. 

ECTOPIAE. 

Genus 

141. 

Hernia. 

li 

142. 

Prolapsus. 

(< 

143. 

Luxatio. 

Ordo  VIII. 

DiALYSES 

Genus 

144. 

Vulnus. 

145. 

Ulcus. 

146. 

Herpes. 

147- 

Tinea. 

148. 

Psora. 

149. 

Fractura. 

150. 

Caries. 

The  simplicity  and  superiority  of  CuUen's  sys- 
tem over  those  of  his  predecessors  are  easily 
valued,  and  show  how  much  progress,  in  descrip- 
tive medicine,  was  made  from  1760  to  1769,  but  it 
leaves  much  to  be  desired.  Its  defects  are  not 
few,  and  many  of  the  enumerated  genera  are,  in 
reality,  species  or  only  symptoms. 

Sagar  of  Vienna  published  (i 771-1776)  a  sys- 
tem of  classification  of  diseases  which  is  such  as 
to  constitute  a  retrogressive  step  in  nosology.    It 


MACBRIDE,    SELLE,   VITET.  11/ 

consists  of  thirteen  classes  :  i,  Vitia  ;  2,  Plagae ; 
3,  Cachexiae  ;  4,  Dolores  ;  5,  Fluxus  ;  6,  Sup- 
pressiones  ;  7,  Spasmi  ;  8,  Anhelationes  ;  9,  De- 
bilitates ;  10,  Exanthemata;  11,  Phlegmasiae  ; 
12,  Febres ;  13,  Vesaniae :  fifty-four  orders  ; 
three  hundred  and  fifty-one  genera  ;  and  twenty- 
five  hundred  species.  • 

Macbride  (1772)  counts  four  classes  :  i,  Uni- 
versal diseases;  2,  Local  diseases;  3,  Sexual 
diseases  ;  4,  Infantile  diseases  :  twenty-three  or- 
ders ;  and  one  hundred  and  eighty  genera. 

Selle's  *'  Iconographia  syst emails  inorborum  7iatu- 
ralis''  {lyjZ)  contains  eighteen  classes:  i,  In- 
flammatory diseases ;  2,  Putrid  diseases ;  3, 
Bilious  diseases  ;  4,  Pituitous  diseases  ;  5,  Verm- 
inous diseases  ;  6,  Lacteous  diseases  ;  7,  Nervous 
diseases  ;  8,  Periodic  diseases  ;  9,  Obstructions  ; 
10,  Gouty  diseases;  11,  Rachitic  diseases;  12, 
Scrophulous  diseases;  13,  Cancerous  diseases; 
14,  Venereal  diseases;  15,  Psoric  diseases;  16, 
Scorbutic  diseases;  17,  Diseases  produced  by 
venoms;  18,  Organic  diseases:  and  forty-seven 
genera. 

This  and  the  four  preceding  systems  were  very 
poor  competitors  of  CuUen's  nosology  which  was 
finally,  in  France  at  least,  replaced  by  Pinel's 
nosology. 

Vitet    (1778,)     arranges     diseases     into    eight 


Il8  DARWIN,    PINEL,    BAUMES. 

classes:  i,  Fevers;  2,  Inflammations;  3,  Pain- 
ful diseases  ;  4,  Convulsions  ;  5,  Debilities  ;  6, 
Evacuatory  diseases  ;  7,  Diseases  by  retention 
of  the  solid  and  liquid  matters  ;  8,  Diseases  of 
the  mind  :  forty-three  orders,  and  three  hundred 
and  ninety-four  genera.  (A  worse  system  even 
than  Sagar's.) 

Darwin  (1794-1796)  adopts  four  classes:  i, 
Diseases  of  irritation  ;  2,  Diseases  of  sensation  ;  3, 
Diseases  of  volition  ;  4,  Diseases  of  association  : 
eleven  orders ;  forty-one  genera ;  and  four  hun- 
dred and  seventy-seven  species.  (An  original  and 
ingenious,  but  inconsistent,  obscure  and  unprac- 
tical system.) 

Pinel's  (1798,)  Jiosographie  philosophique  consists 
of  five  classes  :  i,  Fevers;  2,  Phlegmasiae  ;  3, 
Haemorrhages ;  4,  Neuroses ;  5,  Organic  le- 
sions :  twenty-two  orders ;  and  one  hundred 
and  forty-one  genera. 

Baumes  published  in  1801  a  work  with  the 
title  of  Fondemens  de  la  science  methodique  des 
maladies,  in  which  he  regards  diseases  as  likely  to 
result  from  the  increase  or  from  the  diminution 
of  certain  chemical  agents  existing  in  the  animal 
economy,  such  as  caloric,  oxygen,  nitrogen, 
hydrogen,  and  phosphorus.  This  arrangement 
consists    of    five    classes ;     several    sub-classes ; 


BAUMES.  119 

ninety-seven    genera ;    and    a   great   number   of 
species  and  sub-species. 

CLASS  I.  Calorineses :  diseases  in  which 
the  dominant  phenomena  seem  to  consist  of  an 
alteration  in  the  quantity  of  animal  heat. 

Sub-class  i.  Supercalorineses:  diseases  caused 
by  an  augmentation  of  the  animal  heat. 

Sub-class  2.  Discalorineses  :  diseases  in  which 
the  predominant  phenomena  seem  to  be  owing  to 
a  diminution  of  the  animal  heat. 

CLASS  IL  Oxygeneses  ;  diseases  in  which 
the  state  of  the  system  seems  to  be  allied  to  an 
alteration  in  the  normal  quantity  of  oxygen  in 
the  economy. 

Sub-class  /.  Disoxygeneses :  diseases  caused 
by  a  notable  diminution  in  the  quantity  of  oxygen 
in  the  body. 

Sub-class  2.  Superoxygeneses  :  diseases  where 
the  oxygen  is  in  excess. 

CLASS  IIL  Hydrogeneses :  diseases  in 
which  the  mucous  secretion,  the  fats,  the  bile, 
the  milk,  offer  characters  of  predominence  or 
degeneration. 

CLASS  IV.  Azoteneses :  essentially  putrid 
diseases,  formed  by  the  predominence  of  nitrogen 
in  the  economy. 

CLASS  V.     Phosphoreneses  :  diseases  attrib- 


I20  TOURDES. 

uted  to  an  excess  or  a  diminution  of  the  phos- 
phate of  lime,  or  to  its  decomposition. 

Supplementary  elass.  This  class  contains  seven 
genera  and  certain  sub-genera  consisting  princi- 
pally of  traumatisms. 

Pinel  and  Bricheteau,  from  whose  article  this 
and  several  of  these  abstracts  were  made,  say, 
''  We  have  almost  nothing  to  say  of  Mr.  Baumes' 
nosology,  composed  in  a  moment  of  efferves- 
cence,      This  work,  long  since  judged,  is 

already  of  the  domain  of  history,  and  is  a  new 
proof  of  the  great  errors  which  may  be  com- 
mitted by  a  man  of  talent " 

Tourdes  published,  in  1803,  a  new  classification 
of  diseases,  consisting  of  four  classes,  nineteen 
orders,  and  fifty-one  genera,  founded  upon  the 
existence  of  three  elementary  tissues  which  he 
says  form  the  basis  of  all  the  organs  ;  these  are 
the  nervous,  fibrous,  and  cellular  or  lymphatic, 
tissues. 

Class  I.  Diseases  of  the  fibrous  or  irritable 
tissue. 

Class  II.  Diseases  of  the  nervous  and'  sensi- 
tive tissue. 

Class  III.  Diseases  of  the  cellular  or  lym- 
phatic tissue. 

Class  IV.     Complicated  diseases.     This  class 


RECAMIER.  121 

embraces  simultaneous   diseases  of  several   sys- 
tems or  different  tissues. 

Tourtelle,  in  his  Elemens  de  medecine  Theorique 
et  Pratique  (1805,)  inserts  a  system  of  nosology  in 
which  diseases  are  divided  into  six  classes  ;  one 
hundred  and  eighty-two  genera ;  and  seven 
hundred  and  nine  species. 

Class  I.     Pyrexiae. 
Class  1 1.     Flux. 
Class  III.     Suppressions. 
Class  IV.     Neuroses. 
Class  V.     Cachexiae. 
Class  VI.    Vitia. 


R^camier's  system  of  nosology,  extracted  from 
the  article  of  Pinel  and  Bricheteau  in  the  Die- 
tionaire  des  Sciences  Medicales  18 19,  is  as  fol- 
lows : 


FIRST  SECTION.     Physiological  diseases. 

Class  I.     Alterations  of  the  secretions. 
Class  II.     Phlegmasiae. 
Class  III.     Fevers. 
Class  IV.     Neuroses. 
Class  V.     Cachexiae. 


122  CRICHTON. 


SECOND  SECTION.     Anatomical  diseases. 

Class  VI.     Solution  of  the  tissues. 

Class  VII.     Displacements. 

Class  VIII.  Physical  vices  of  the  arterial,  ven- 
ous or  lymphatic  circulation. 

Class  IX.  Physical  vices  of  the  digestive,  lacry- 
mal,  salivary,  bilious,  urinary, 
spermatic,  and  uterine  excretions. 

Class  X.     Deformities,  congenital  or  accidental. 

Class  XI.     Foreign  bodies. 

Each  class  contains  four  orders,  and  certain 
genera  and  species. 

Crichton's  system  consists  of  eight  classes; 
thirty  orders ;  and  one  hundred  and  seventy- 
eight  genera. 

Parr,  the  author  of  the  London  Medical  Dic- 
tionary, who  so  ably  criticised  the  nosographers 
that  were  contemporaneous  with,  or  preceded 
him,  omitted  classes  and  recognized  only  orders, 
of  which  he  made  twelve;  genera,  thirty -four; 
species,  two  hundred  and  twenty-one ;  and  a 
number  of  sub-species  and  of  varieties. 

The  following  is  a  synopsis  of  Parr's  system 
from  which  most  of  the  species  and  all  the  sub- 
species and  varieties  are  omitted. 


123 


SYNOPSIS   OF  PARR  S   SYSTEM. 

Order  I.     Pyrexiae. 

Genus  I.     hit  er  mitt  ens, 
[5  species]. 

Genus  II.     Exacerbans. 
[3  species]. 

Genus  III.     Continua. 


Sp.   I.     Synocha. 
"     2.     Typhus. 

[3  sub-species]. 
"     3.     Synochus. 


Order  II.    Phlegmasiae. 


Genus  I. 

Sp.     I.  Phleg-mon. 

2.  Ophthalmia. 

3.  Phrenitis. 

4.  Cynanche. 

5.  Pneumonia. 

6.  Hepatitis. 

7.  Carditis. 

8.  Gastritis. 

9.  Enteritis. 

10.  Nephritis. 

11.  Cystitis. 


Inflaminatio. 


124 


SYNOPSIS   OF   parr's   SYSTEM. 


Sp. 

12. 

Hysteritis. 

<< 

13- 

Odontalgia. 

^Various  sub-species]. 

Genus  II. 

Phlogosis. 

Sp. 

I. 

Erythema. 

it 

2. 

Phrenitica. 

(( 

3- 

Anginosa. 

<( 

4- 

Pneumonica. 

a 

5- 

Puerperalis. 

Genus  III. 

Catarrhus. 

Sp. 

I. 

Coryza. 

^4  sub-species\ 

<< 

2. 

Dysenteria. 

a 

3- 

Phthisis. 

a 

4- 

Coeliaca. 

ii 

5- 

Leucorrhoea. 

it 

6. 

Cystirrhoea. 

11 

7- 

Gonorrhoea. 

<( 

8. 

Leucorrhois. 

Genus  IV. 

Arthritis. 

4  species]. 

Genns  V. 

Exostosis. 

Sp, 

,  I. 

Periostea. 

SYNOPSIS   OF   PARRS   SYSTEM.  12$ 

Order  III.    Eruptiones. 

Genus  I,     Exanthemata. 

[13  species]. 

Genus  II.     Efflorescentia. 
[9  species]. 

Order  IV.    Profluvia. 

Genus  I.     Haemorrhagia. 
[9  species,  including  Haematuria]. 

Genus  II.     Apocenosis^ 
[9  species,  including  Diabetes  and  Diuresis.] 

Order  V.    Suppressorii. 

Genus  L     Constrictoria. 

Sp.  I.  Dysphagia. 
"  2.  Obstipatio. 
"     3.     Polypus. 

Genus  IL     Aiihelatio. 

Sp.   I.     Asthma. 
"     2.     Dyspnoea. 

[8  sub-species]. 

Genus  IIL     Epischesis. 
[9  species,  among  which] 

Sp.  5.     Ischuria 

a.  Renalis 


126 


SYNOPSIS  OF  PARR  S   SYSTEM. 


b.  Ureterica 

c.  Vesicalis 

d.  Urethralis. 
Sp.  6.     Dysuria 

a.  Ardens 

b.  Spasmodica 

c.  Compressionis 

d.  Irritata. 

"     8.     Dyspermatismus 

a.  Organicus 

b.  Spasmodicus. 

Order  VI.    Spasmi. 


Sp. 


Genus  L     Tonos. 

I. 

2. 

3- 

4- 
5- 

Trismus. 

Tetanus. 

Contractura. 

Priapismus. 

Strabismus. 

Genus  II.     Clonos. 
'\\  species]. 

Order  VII.    Adynamiae. 


Genus  I.     Coma. 
[4  species]. 


SYNOPSIS   OF  PARR  S   SYSTEM. 

Genus  II.     Anepithymia. 
[7  species]. 

Order  VIII.    Paranoias. 

Genus  I.     Morositas. 
[3  species]. 

Genus  II.     Halhicinatio. 

Sp.   I.     Satyriasis. 
"•     2.     Nymphomania. 
"     3.     Erotomania. 

Gen74s  III.     Vesania. 
[3  species]. 

Order  IX.    Cachexiae. 

Genus  I.     Impetigo. 

Sp.  I.  Scorbutus. 

"     2.  Syphilis. 

"     3.  Aurigo. 

"     4.  Phaenigmus. 

''     5.  Melasma. 

"■     6.  Rubigo. 

Genus  II.     Macula. 

Sp.   I.     Ecchymosis. 
"■     2.     Petechia. 


127 


128  SYNOPSIS   OF   parr's   SYSTEM. 

Order  X.    Intumescentiae. 

Genus  I.      Tuber, 
[i6  species]. 

Genus  IL     Phleginatia. 
[8  species,  including  Hydrocele]. 

Ge7ius  III.     Cystis. 
[6  species]. 

Genus  IV.     Emphysema. 
[3  species]. 

Order  XL    Ectopiae. 

Genus  I.     Hernia. 
[8  species]. 

Genus  II,     Prolapsus. 
[7  species,  including  Exocyste]. 

Genus  III.     Luxatio. 
[21  species]. 

Order  XII.    Plagae. 

Genus  I     Dialysis, 
[7  species]. 

Genus  II     CI  as  is, 
[4  species]. 


SWEDIAUR,   YOUNG,   RICHERAND.  1 29 

Genus  III,     Diastasis. 
Sp.   I.     Symphisis  Pubis. 

Swediaur  enumerates  five  classes,  thirty-two 
orders  ;  and  one  hundred  and  thirty-eight  genera. 

Young,  in  his  system  of  practical  nosology, 
adopts  five  classes:  (i,)  Paraneurismi,  diseases 
of  the  nervous  and  muscular  system;  (2,)  Par- 
haemasiae,  diseases  of  the  sanguiferous  system  ; 
(3,)  Pareccrises,  diseases  of  the  secretions  ;  (4,) 
Paramorphiae,  structural  diseases;  (5,)  Ectopiae, 
displacements:  seven  orders;  and  seventy-nine 
genera. 

Richerand,  in  his  nosographie  ckirurgicale,  fourth 
edition,  adopts  only  three  classes  :  (i,)  Physical 
lesions  resulting  from  the  action  of  a  mechanical 
cause ;  (2,)  Organic  or  structural  lesions ;  (3,) 
Vital  lesions  :  and  fourteen  orders. 

Richerand  afterwards  introduced  a  new  classi- 
fication consisting  of  eight  classes:  (i,)  Diseases 
which  affect  all  the  organic  systems  ;  (2,)  Dis- 
eases of  the  sensitive  apparatus  ;  (3,)  Diseases  of 
the  locomotory  apparatus ;  (4,)  Diseases  of  the 
digestive  apparatus  ;  (5,)  Diseases  of  the  circula- 
tory apparatus  ;  (6,)  Diseases  of  the  respiratory 
apparatus  ;  (7,)  Diseases  of  the  cellular  system  ; 
(8,)  Diseases  of  the  sexual  organs :  and  sixteen 
orders. 


130       good's  table  of  classification. 

Good's  system  comprises  six  classes:  (i,) 
Coeliaca,  diseases  of  the  digestive  function ;  (2,) 
Pneumatica,  diseases  of  the  respiratory  function  ; 
(3,)  Haematica,  diseases  of  the  sanguineous  func- 
tion ;  (4,)  Neurotica,  diseases  of  the  nervous  func- 
tion; (5,)  Genetica,  diseases  of  the  sexual  func- 
tion ;  (6,)  Eccritica,  diseases  of  the  excernent 
function ;  and  is  further  divided  into  orders, 
genera  and  species,  as  follows. 


DOCTOR  good's   **  TABLE  OF  CLASSIFICATION."  * 

CLASS.  1.     COELIACA. 

Diseases  of  the  digestive  function. 

Ord.  L     Enterica. 
Affecting  the  alimentary  canal. 

Gen.  1.     Odontiay 
Misdentition. 

Spec.  I.  O.  Dentitionis,  (Teething.) 
"     2.       "  Dolorosa,  (Toothache.) 
"     3.       "  Stuporis,  (Toothedge.) 
"     4.       "  Deformis,  (Deformity  of  the  teeth.) 


*  Extracted    from    "  The    Study    of    Medicine,"     Vol.    i. 
London,   1822. 


GOOD  S  TABLE   OF   CLASSIFICATION.  I3I 

Spec.  5.     O.  Edentula,  (Toothlessness.) 

"     6.       *'  Incrustans,  (Tartar  of  the  teeth.) 
"     7.       *'  Excressens,  (Excrescent  gums.) 

Gen.  11.     PtyalisinuSy 
Ptyalism. 

Spec.   I.     P.  Acutus,  (Salivation.) 

"     2.       *'  Chronicus,  (Chronic  ptyalism.) 
"     3.       ''  Iners,  (Drivelling.) 

6^^;/.  ///.     Dysphagia, 
Dysphagy. 

Spec.   I.  D.  Constricta,  (Constrictive  dysphagy.) 
"     2.       **  Atonica,  (Atonic  disphagy.) 
"     3.       "  Globosa,  (Nervous  quinsy.) 
"     4.       "  Uvulosa,  (Uvular  dysphagy.) 
**     5.       "  Linguosa,  (Lingual  disphagy.) 

Gen,  IV.     Dipsosis, 
Morbid  thirst. 

Spec.   I.     D.  Avens,  (Immoderate  thirst.) 
"     2.       "  Expers,  (Thirstlessness.) 

6^^?2.    V,     Limosis, 
Morbid  appetite. 

Spec.   I.     L.  Avens,  (Voracity.) 
"     2.       "  Expers,  (Long  fasting.) 


132       good's  table  of  classification. 

spec.  3.       "  Pica,  (Depraved  appetite.) 

"     4.       "  Cardialgia,       (Heart-burn,       Water- 
brash.) 

5.  "  Flatus.  (Flatulency.) 

6.  "  Emesis,  (Sickness,  vomiting.) 

7.  ''  Dyspepsia,  (Indigestion.) 


Gen.    VI.     Colica^ 
Colic. 

Spec.  I.  C.  Ileus,  (Iliac  passion.) 

"     2.  "  Rhachialgia,  (Colic  of  Poitou,  Pain- 
ters colic.) 

"     3.  "  Cibaria,  (Surfeit.) 

*'     4.  "  Flatulenta,  (Wind  colic.) 

^'     5.  "  Constipata,  (Constipated  colic.) 

"     6.  "  Constricta,  (Constrictive  colic.) 

Gen.    VII.     Coprostasis^ 
Costiveness. 

Spec.  I.     C.  Constipata,  (Constipation.) 
"     2.       '*  Obstipata,  (Obstipation.) 

Gen.   VIII.     Diarrhoea, 
Looseness. 

Spec.  I.     D.  Fusa,  (Feculent  looseness.) 
"     2.       "  Biliosa,  (Bilious  looseness.) 


good's  table  of  classification.        133 

spec.  3.  "  Mucosa,  (Mucous  looseness.) 

4.  "  Chylosa,  (Chylous  looseness.) 

5.  "  Lienteria,    (Lientery.) 

6.  "  Serosa,  (Serous  looseness.) 

7.  "  Tubularis,  (Tubular  looseness.) 

8.  "  Gypsata,  (Gypseous  looseness.) 

Gen.  IX.     Cholera, 
Cholera. 

Spec.   I.     C.  Biliosa,  (Bilious  cholera.) 
"     2.      "    Flatulenta,  (Wind  cholera.) 
"     3.      "   Spasmodica,  (Spasmodic  cholera.) 

Gen.  X.     Enter olithus^ 
Intestinal  concretions. 

Spec.  I.     E.  Bezoardus,  (Bezoar.) 

"     2.       "  Calculus,  (Intestinal  calculus.) 
"     3.       "  Scybalum,  (Scybalum.) 

Gen.  XI.     Helmmthia^ 
Worms. 

Spec.   I.     H.  Alvi,  (Alvine  worms.) 
"     2.       "  Podicis,  (Anal  worms.) 
"3.       "  Eri'atica,  (Erratic  worms). 


134  GOODS   TABLE   OF   CLASSIFICATION. 

Gen.  XII.     Proctica^ 
Proctica. 

Spec.   I.     P.  Simplex,  (Simple  proctica.) 

"     2.       '*  Spasmodica,  (Spasmodic  stricture  ot 

the  rectum.) 
"     3.       "  Callosa,    (Callous    stricture    of    the 

rectum.) 
''     4.       "  Tenesmus,   (Tenesmus.) 
"     5.       "  Marisca,  (Piles.) 
"     6.       "  Exania,  (Prolapse  of  the  fundament.) 

Ord.  II.     Splanchnica, 
Affecting  the  coUatitious  viscera. 

Gen.  I.     Icterus^ 
Yellow  Jaundice. 

Spec.   I.  I.  Choloeus,  (Biliary  jaundice.) 

"     2.  '*  Chololithicus,  (Gall-stone  jaundice.) 

"     3.  "  Spasmodicus,  (Spasmodic  jaundice.) 

"     4.  "  Hepaticus,  (Hepatic  jaundice.) 

"     5.  "  Infantum,  (Jaundice  of  infants.) 

Gen.  II.     Melaena, 
Melena. 

Spec.  I.     M.  Choloea,  (Black,  or  green  jaundice.) 
"     2.       "  Cruenta,  (Black  vomit.) 


good's  table  of  classification. 


I3S 


Geii.  III.     Chololithus, 
Gall-stone. 

Spec.   I.     C.  Quiescens,  (Quiescent  gall-stone.) 
'*     2.       "  Means,  (Passing  of  gall-stones ) 

Gen.  IV.     Parabysma^ 


Spec.  I 
2 

3 

4 

5 
6 


Visceral  turgescence. 

P.  Hepaticum,     (Turgescence     of    the 

liver.) 

"  Splenicum,  (Turgescence  of  the 
spleen.) 

"  Pancreaticum,  (Turgescence  of  the 
pancreas.) 

"  Mesentericum,  (Turgescence  of  the 
mesenter}^) 

"  Intestinale,  (Turgescence  of  the  in- 
testines.) 

"  Omentale,  (Turgescence  of  the 
omentum.) 

"  Complicatum,  (Turgescence  com- 
pounded of  various 
organs.) 


136       good's  table  of  classification. 

CLASS.  11.     PNEUMATICA. 

Diseases  of  the  respiratory  function. 

Ord.  I.     Phonica, 
Affecting-  the  vocal  avenues. 

Gen.  I.     Coryza^ 
Running  at  the  nose. 

Spec.  I.     C.  Entonica,  (Entonic  coryza.) 
"     2.      "    x\tonica,  (Atonic  coryza.) 

Gen.  II.     Polypus^ 
Polypus. 

Spec.  I.     P.  Elasticus,  (Compressible  "polypus.) 
"     2.      "  Coriaceus,  (Cartilaginous  polypus.) 

Gen.  III.     Rhonchus, 
Rattling  in  the  throat. 

Spec.  I.     R.  Stertor,  (Snoring.) 
"     2.      *'    Cerchnus,  (Wheezing.) 

Gen.  IV.     Aphonia, 
Dumbness. 

Spec.  I.     K.  Elinguium,  (Elingual  dumbness.) 
"     2.       "  Atonica,  (Atonic  dumbness.) 
"     3.       "  Surdorum,  (Deaf-dumbness.) 


good's  table  of  classification.        137 

Gen.    V.     Dysphonia, 
Dissonant  voice. 

Spec,  I.     D.  Susurrans,  (Whispering  voice.) 
"     2.       "  Puberum,  (Voice  of  puberty.) 
"     3.       **  Immodulata,  (Immelodious  voice.) 

Geu.    VI.     Psel/zsmus, 
Dissonant  speech. 

Spec.  I.     P.  Bambalia,  (Stammering.) 
'*     2.      "    Blaesitas,  (Misenunciation.) 

Ord.  II.    Pneumonica, 

Affecting  the  lungs,  their  membranes,  or  motive 

power. 

Gen.  I.     Bex, 
Cough. 

Spec.   I.     B.  Humida,  (Common  or  tumid  cough.) 
"     2.      ''  Sicca,  (Dry  cough.) 
"     3.      "  Convulsiva,  (Hooping  cough.) 

Gen.  II.     Laryngysinus, 
Laryngic  suffocation. 

Spec.  I.     L.  Stridulus,  (Stridulous  constriction  of 

the  larynx.) 


138       good's  table  of  classification. 

Gen.  III.     Dyspnoea  J 
Anhelation. 

Spec.   I.     D.  Chronica,  (Short-breath.) 

"     2.       "  Exacerbans,     (Exacerbating    anhela- 
tion.) 

Gen.  IV.     Asthma^ 
Asthma. 

Spec.  I.     A.  Siccum,  (Dry  or  nervous  asthma.) 
"     2.       "  Humidum,      (Humid     or     commom 

asthma.) 

Gen.    V.     Ephialtes, 
Incubus. 

Spec.   I.     E.  Vigilantium,  (Day-mare.) 
"     2.      "  Nocturnus,  (Night-mare.) 

Gen.    VI.     Sternalgia, 
Suffocative  breast-pang. 

Spec,   I.     S.  Ambulantiura,  (Acute  breast-pang.) 
^*     2.       "  Chronica,  (Chronic  breast-pang. 

Gen.    VII.     Fleuralgia^ 
Pain  in  the  side. 

Spec.   I.     P.  Acuta,  (Stitch.) 

'*     2.       "  Chronica,  (Chronic  pain  in  the  side.) 


good's  table  of  classification.        139 

CLASS.  III.     HAEMATICA, 
Diseases  of  the  sanguineous  function. 

Ord.  I.     Pyretica, 
Fevers. 

Gen.  I.     Ephemera, 
Diary  fever. 

Spec,   I.     E.  Mitis,  (Wild  diary  fever.) 
"     2.       "  Acuta,  (Acute  diary  fever.) 
"     3.       "  Sudatoria,  (Sweating  fever.) 

Gen,  II,     Anetus, 
Intermitting  fever.     Ague. 

A.  Quotidianus,  (Quotidian  ague.) 
"  Tertianus,  (Tertian  ague.) 
"  Quartanus,  (Quartan  ague.) 
**  Erraticus,  (Irregular  ague.) 
"■  Complicatus,  (Complicated  ague.) 

Gen.  Ill     Epanetus^ 
Remittent  fever. 

Spec,   I.     E.  Mitis,  (Wild  remittent.) 

"     2.      "  Malignus,  (Malignant  remittent.) 
"     3.      "  Hectica,  (Hectic  fever.) 


^pec. 

I. 

n 

2. 

(( 

3. 

<( 

4. 

<( 

5. 

140  GOOD  S   TABLE   OF  CLASSIFICATION. 

Gen.  IV.     Enecia^ 
Continued  fever. 

Spec.  I.     E.  Cauma,  (Inflammatory  fever.) 
"     2.      "  Typhus,  (Typhus  fever.) 
"     3.      "  Synochus,  (Synochal  fever.) 

Ord.  II.     Phlogotica, 
Inflammations. 

Gen.  I.     Apostema^ 
Aposteme. 

A.  Commune,  (Common  aposteme.) 
**    Psoaticum,  (Psoas  abscess.) 
"    Hepaticum,  (Abscess  of  the  liver.) 
"    Empyema,  (Lodgement  of  matter  in 
the  chest.) 
"     5.      "   Vomica,  (Vomica.) 

Gen.  II.     Phlegmoney 
Phlegmon. 

Spec.  I.  P.  Communis,  (Common  phlegmon.) 

2.  "  Parulis,  (Gumboil.) 

3.  "  Auris,  (Imposthume  in  the  ear.) 

4.  "   Parotidea,  (Parotid  phlegmon.) 

5.  "  Mammae,  (Abscess  of  the  breast.) 

6.  "■  Bubo,  (Bubo.) 

7.  "  Phimotica,  (Phimotic  phlegmon.) 


Spee. 

I. 

n 

2. 

It 

3- 

n 

4- 

GOOD  S   TABLE   OF   CLASSIFICATION.  I4I 

Gen.  III.     FJiyma^ 
Tubercle. 

Spec.  I.  P.  Hordeolum,  (Sty.) 

"     2.  ''    Furunculus,  (Boil.) 

"     3.  "    Sycosis,  (Sycous  phyma.) 

"     4.  "   Anthrax,  (Carbuncle.) 

Ge72,  IV.     lonthiis, 
Whelk. 

Spec.  I.     I.  Varus,  (Stone-pock.) 

"     2.      "  Corymbifer,  (Carbuncled  face,   Rosy 

drop.) 

Gen.    V.     PhlysiSj 
Phlysis. 

Spec.  I.     P.  Paronychia,  (Whitlow.) 

Gen.    VI.     Erythema y 
Inflammatory  blush. 

Spec.  I.  E.  Oedematosum,  (Edematous  inflam- 
mation.) 

"  2.  '*  Erysipelatosum,  (Erysipelatous  in- 
flammation.) 

"  3.  "  Gangraenosum,  (Gangrenous  inflam- 
mation.) 

"     4.      "  Vesiculare,  (Vesicular  inflammation.) 


142       good's  table  of  classification. 

spec.  5.     E.  Pernio,  (Chilblain.) 
"     6.      "  Intertrigo,  (Fret.) 


Gen.    V 11.     Empresma^ 
Visceral  inflammation. 


Spec.   I.     E.  Cephalitis,      (Inflammation     of     the 

brain.) 

2.  "  Otitis,  (Ear-ache.) 

3.  "  Parotitis,  (Mumps.) 

4.  "  Paristhmitis,  (Quinsy.) 

5.  "  Laryngitis,      (Inflammation     of     the 

larynx. 

6.  "  Bronchitis,  (Croup.) 

7.  "  Pneumonitis,  (Peripneumony.) 

8.  "  Pleuritis,  (Pleurisy.) 

9.  "  Carditis,  (Inflammation  of  the  heart.) 

10.  "  Peritonitis,     (Inflammation     of     the 

peritoneum.) 

11.  "  Gastritis,       (Inflammation     of      the 

stomach.) 

12.  "  Enteritis,(Inflammation  of  the  bowels.) 

13.  "  Hepatitis,  (Inflammation  of  the  liver.) 

14.  "  Splenitis,  (Inflammation  of  the  spleen.) 

15.  "  Nephritis,      (Inflammation     of     the 

kidneys  ) 

16.  "  Cystitis,(Inflammation  of  the  bladder.) 


good's  table  of  classification.        143 

spec.   17.     E.  Hysteritis,      (Inflammation    of    the 

womb.) 
"     18.      "  Orchitis,  (Inflammation  of  the   tes- 
ticles.) 

Gen.    VIIL     Ophthalmia^ 
Ophthalmy. 

Spec.   I.  O.  Taraxis,  (Lachr3^mose  ophthalmy.) 

"     2.  ''    Iridis,  (Inflammation  of  the  iris.) 

"     3.  "    Purulenta,  (Purulent  ophthalmy.) 

''     4.  "    Glutinosa,  (Glutinous  ophthalmy.) 

"     5.  *'    Chronica,  (Lippitude,  Blear  eye.) 

Gen.  IX.     CatarrhuSj 
Catarrh. 

Spec.  I.     C.  Communis,(Cold  in  the  head  or  chest.) 
"     2.      "    Epidemicus,  (Influenza.) 

Gen.  X,     Dysenteria^ 
Dysentery. 

Spec.   I.     D.  Simplex,  (Simple  dysentery.) 
"     2.      "    Pyrectica,  (Dysenteric  fever.) 

Gen.  XL     Btic?iemia, 
Tumid  leg. 

Spec.  I.     B.  Sparganosis,  (Puerperal  tumid  leg.) 
.     "     2.      "    Tropica,  (Tumid  leg  of  hot  climates.) 


144       good's  table  of  classification. 

Gen.  XII.     Arthrosia. 
Articular  inflammation. 

Spec.   I.  A.  Acuta,  (Acute  rheumatism.) 

'*     2.  "    Chronica,  (Chronic  rheumatism.) 

"     3.  "•    Podagra,  (Gout) 

"     4.  "    Hj^drarthrus,  (White-swelling.) 

OrD.    III.      EXANTHEMATICA, 

Eruptive  fevers,  Exanthems. 

Gen.  I.     EnanthesiSy 
Rash,  Exanthem. 

Spec.  I.     E.  Rosalia,   (Scarlet-fever.) 
*'     2.      "  Rubeola,  (Measles.) 
"     3.      "■  Urticaria,  (Nettle-rash.) 

Gen.  II.     Emphlysis, 
Ichorous  exanthem. 

Spec.   I.  E.  Miliaria,  (Miliary  fever.) 

"     2.  "    Aphtha,  (Thrush.) 

"     3.  "    Vaccinia,  (Cow-pox.) 

"     4.  "    Varicella,  (Water-pox.) 

"     5.  "    Pemphigus,  (Vesicular   or  bladdery 

fever.) 

"     6.  "   Erysipelas,  (St.  Anthony's  fire.) 


good's  table  of  classification.        145 

Gen.  III.     Empyesis, 
Pustulous  exanthem. 

Spec.  I.     E.  Variola,  (Small-pox.) 

Gen.  IV.     Aftthraciay 
Carbuncular  exanthem. 

Spec.  I.     A.  Pestis,  (Plague.) 
"     2.      '*    Rubula,  (Yaws.) 

Ord.  IV.     Dysthetica, 
Cachexies. 

Gen.  I.     Plethora^ 
Plethora. 

Spec.  I.     P.  Entonica,  (Sanguine  phthora.) 
"     2.      "   Atonica,  (Serous  plethora.) 

Gen.  II.     Hae^norrhagia^ 
Haemorrhage. 

Spec.   I.     H.  Entonica,  (Entonic  Haemorrhage.) 
"     2.       *'  Atonica,  (Atonic  Haemorrhage.) 

Gen.  III.     Marasmus^ 
Emaciation. 

Spec.  I.     M.  Atrophia,  (Atrophy.) 

"     2.      "    Climactericus,  (Decay  of  nature.) 


146       good's  table  of  classification. 

spec.  3.     M.  Tabes,  (Decline.) 

"     4.      "    Phthisis,  (Consumption.) 

Gen.  IV.     Struma, 
Scrophula. 

Spec.   I.     S.  Vulgaris,  (King's  evil.) 

Gen.    V.     Carcinus, 
Cancer. 

Spec.  I.     C.  Vulgaris,  (Common  cancer.) 

Gen.    VI.     Lues, 
Venereal  disease. 

Spec.  I.     L.  Syphilis,  (Pox.) 

"     2.      "•  Syphilodes,  (Bastard  pox.) 

Gen.    VII.     Elephantiasis, 
Elephant-skin. 

Spec,   I.     E.  Arabica,  (Arabian  elephantiasis, 

Black  leprosy.) 
"     2.      *'    Italica,  (Italian  elephantiasis.) 
"     3.      *'    Asturiensis,  (Asturian  elephantiasis.) 

Gen.    VIII.     Catacausis, 
Catacausis. 

Spec.  I.     C.  Ebriosa,  (Inebriate  catacausis.) 


good's  table  of  classification.        147 

Gen.  IX.     PorpJiyrUy 
Scurvy. 

Spec.  I.     P.  Simplex,  (Petecchial  scurvy.) 
*'     2.      ''    Haemorrhagica,  (Land-scurvy.) 
"     3.      "•    Nautica,  (Sea-scurvy.) 

Gen.  X.     Exarigia, 
Exangia. 

Spec.   I.     E.  Aneurisma,  (Aneurism.) 
"     2.      "    Varix,  (Varix.) 
"     3.      "    Cyania,  (Blue-skin,) 

Gen.  XL     Gangraena, 
Gangrene. 

Spec.  I.  G.  Sphacelus,  (Mortification.) 

"  2.       "  Ustilaginea,  (Mildew-mortification.) 

" '  3.       "  Necrosis,  (Dry  gangrene.) 

"  4.       ''  Caries,  (Caries.) 

Gen.  XII.      UlcuSy 
Ulcer. 

6/>^^.  I.     CJ.  Incarnans,  (Simple  healing  ulcer.) 
"     2.      '*    Vitiosum,  (Depraved  ulcer.) 
"     3.      "    Sinuosum,  (Sinuous  ulcer.) 
"     4.      "    Tuberculosum,    (Warty,    excrescent 

ulcer.) 
**     5.      "    Cariosum,  (Carious  ulcer.) 


148       good's  table  of  classification. 

CLASS.  IV.     NEUROTICA, 

Diseases  of  the  nervous  function. 

Ord.  I.     Phrenica, 
Affecting  the  intellect. 

Gen.  I.     Ecphronia^ 
Insanity,  Craziness. 

Spec,   I.     E.  Melancholia,  (Melancholy.) 
"     2.      *'  Mania,  (Madness.) 

Gen.  II,     Empathema, 
Ungovernable  passion. 

Spec.   I.     E.  Entonicum,      (Empassioned     excite- 
ment.) 
**     2.      '*    Atonicum,      (Empassioned      depres- 
sion.) 
"     3.      *'    Inane,  (Hair-brained  passion.) 

Gen.  III.     Alusia, 
Illusion,  Hallucination. 

Spec.  I.     A.  Elatio,  (Sentimentalism,    Mental  ex- 
extravagance.) 
"     2.       "    Hypochondrias,      (Hypochondrism, 

Low  spirits.) 


good's  table  of  classification.        149 

Gen.  IV.     Aphelxia, 
Revery. 

Spec.  I.     A.  Socors,  (Abscence  of  mind.) 
"     2.      •*    Intenta,  (Abstraction  of  mind.) 
"     3.      "    Otiosa,  (Brown-study.) 

Gen.    V.     Paroniria, 
Sleep-disturbance. 

Spec.   I.     P.  Ambulans,  (Sleep-walking.) 
"     2.      '*  Loquens,  (Sleep-talking.) 
"     3.      "  Salax,  (Night-pollution.) 

Gen.    VI.     Moria, 
Fatuity. 

Spec.   I.     M.  Imbecillis,  (Imbecility.) 
"     2.       "    Demens,  (Irrationality.) 

Ord.  II.    Aesthetica, 
Affecting  the  sensation. 

Gen.  I.     Par  op  sis, 
Morbid  sight. 

Spec,  I.     P.  Lucifuga,  (Night-sight.) 
"     2.      "    Noctifuga,  (Day-sight.) 
"     3.      "    Longinqua,  (Long-sight.) 


ISO       good's  table  of  classification. 


^ec 

■  4. 

5. 

6. 

7- 

8. 

9- 

10. 

II. 

12. 

13- 

P.  Propinqua,  (Short-sight.) 

"  Lateralis,  (Skue-sight.) 

"  Illusoria,  (False-sight.) 

"  Caligo,  (Opaque  cornea.) 

"  Glaucosis,  (Humoral  opacity.) 

"  Catarracta,  (Cataract.) 

"  Synizesis,  (Closed  pupil.) 

**  Amaurosis,  (Drop  serene.) 

"  Staphyloma,  (Protuberant  eye.) 

"■  Strabismus,  (Squinting.) 


Spec. 

I. 

2. 

3- 

4- 

5. 

6. 

(7^?;.  //.     Paracusis^ 
Morbid  hearing. 

P.  Acris,  (Acute  hearing.) 
"  Obtusa,  (Hardness  of  hearing.) 
"  Perversa,  (Perverse  hearing.) 
"  Duplicata,  (Double  hearing.) 
"  Illusoria,  (Imaginary  sounds.) 
"  Surditas,  (Deafness.) 


Gen.  III.     ParosmiSf 
Morbid  smell. 


Spec.   I.     P.  Acris,  (Acute  smell.) 
**     2.      "  Obtusa,  (Obtuse  smell.) 
"     3.      "  Expers,  (Want  of  smell.) 


good's  table  of  classification.        151 

Gen,  IV.     Parageusis, 
Morbid  taste. 

Spec.  I.     P.  Acuta,  (Acute  taste.) 
*'     2.      "  Obtusa,  (Obtuse  taste.) 
"     3.      "  Expers,  (Want  of  taste.) 

Gen.    V.     Par  apsis, 
Morbid  touch. 

Spec.  I.  P.  Acris,  (Acute  sense  of  touch  or  gen- 
eral feeling.) 

"     2.      "    Expers,  (Insensibility    of    touch    or 

general  feeling.) 

"     3.      '*    Illusoria,  (Illusory  sense  of  touch  or 

general  feeling.) 

Gen.    VI.     Neuralgia, 
Nerve-ache. 

Spec.  I.  N.  Faciei,  (Nerve-ache  of  the  face.) 
"  2.  •'  Pedis,  (Nerve-ache  of  the  foot.) 
"     3.      "    Mammae,  (Nerve-ache  of  the  breast.) 


152 


good's  table  of  classification. 


spec.   I 

2 

3 

4 

5 
6 

7 
8 


OrD.    III.      CiNETICA, 

Affecting  the  muscles. 

Gen.  I.     Entasia, 
Constrictive  spasm. 

E.  Priapismus,  (Priapism.) 

"■  Loxia,  (Wry-neck.) 

"  Articularis,  (Muscular  stiff-joint.) 

"  Systremma,  (Cramp.) 

"  Trismus,  (Locked-jaw.) 

"  Tetanus,  (Tetanus.) 

"  Lissa,  (Rabies,  Canine  madness.) 

"  Acrotismus,  (Suppressed  pulse.) 


Gen.  II.     Clonus y 
Clonic  spasm. 

Spec,  I.     C.  Singultus,  (Hiccough.) 
"     2.      ''    Sternutatio,  (Sneezing.) 
'    Palpitatio,  (Palpitation.) 

*  Nictitatio,    (Twinkling   of    the   eye 
lids.) 

'    Subsultus,    (Twitching   of    the   ten 
dons.) 

*  Pandiculatio,  (Stretching.) 


3- 
4- 

5. 
6. 


spec. 

I. 

(< 

2. 

<< 

3- 

<( 

4. 

<( 

5. 

good's  table  of  classification.       153 

Gen.  HI.     Sync  I  onus, 
Synclonic  spasm. 

S.  Tremor,  (Trembling.) 
''  Chorea,  (St.  Vitus'  dance.) 
"  Ballismus,  (Shaking  palsy.) 
'*  Raphania,  (Raphania.) 
"  Beriberia,  (Barbiers.) 


Ord.  IV.     Systatica, 

Affecting  several  or  all  the  sensorial  powers 
simultaneously. 

Gen,  /,     Agrypnia^ 
Sleeplessness. 

Spec.   I.     A.  Excitata,  (Irritative  wakefulness.) 
"     2.       "  Pertaesa,  (Chronic  wakefulness.) 

Gen.  II.     Dysphoria, 
Restlessnes. 

Spec.  I.     D.  Simplex,  (Fidgets.) 
"     2.      "    Anxietas,  (Anxiety.) 

Gen.  Ill    Antipathia, 
Antipathy. 

Spec.   I.     A.  Sensilis,  (Sensile  antipathy.) 

2.      ''  Insensilis,  (Insensile  antipathy.) 


154       good's  table  of  classification. 

Gen.  IV.     Cephalaea^ 
Head-ache. 

Spec.  I.  C.  Gravans,  (Stupid  head-ache.) 

2.  "    Ecstasis,  (Ecstasy.) 

3.  "   Catalepsia,  (Catalepsy.) 

4.  "    Lethargus,  (Lethargy.) 

5.  ''    Apoplexia,  (Apoplexy.) 

6.  "    Paralysis,  (Palsy.) 


CLASS.  V.     GENETICA, 
Diseases  of  the  sexual  function. 

Ord.  L     Cenotica, 
Affecting  the  fluids. 

Gen.  /.     Paramenia  J 
Mismenstruation. 

Spec.  I.     P.  Obstructionis,  (Obstructed  menstrua- 
tion.) 
"     2.      "  Difficilis,  (Laborious  mentruation.) 
"     3.      "  Superflua,  (Excessive  menstruation.) 
"     4.      "  Erroris,  (Vicarious  menstruation.) 
"     5.      "  Cessatronis,    (Irregular   cessation   of 

the  menses.) 


GOOD  S   TABLE   OF   CLASSIFICATION.  1 55 

Genus  II.     Leucorrhoea, 
Whites. 

Spec.   I.     L.  Communis,  (Common  whites.) 
"     2.      **    Nabothi,  (Labour-show.) 
"     3.      *'   Senescentium,  (Whites  of  advanced 

life.) 

Gen,  III.     Blennorrhoea^ 
Gonorrhoea. 

Spec.  I.     B.  Simplex,  (Simple  urethral  running.) 
"     2.      "    Luodes,  (Clap.) 
"     3.      **   Chronica,  (Gleet.) 

Gen.  IV.     Spermorrhoea^ 
Seminal  flux. 

Spec.  I.     S.  Entonica,  (Entonic  seminal  flux.) 
"     2.      "   Atonica,  (Atonic   seminal  flux.) 

Gen.    V.     GalactiUy 
Mislactation. 

Spec.  I.  G.  Praematura,  (Premature  milk-flow.) 

**     2.  "  Defectiva,  (Deficient  milk-flow.) 

*'     3.  "  Depravata,  (Depraved  milk-flow.) 

"     4  "  Erratica,  (Erratic  milk-flow.) 

"     5.  '*  Virorum,  (Milk-flow  in  males.) 


156       good's  table  of  classification. 

Ord.  II.    Orgastica, 
AiEfecting  the  org-asm. 

Gen.  I.     Chlorosis. 
Green-sickness. 

Spec.  I.     C.  Entonica,  (Entonic  green-sickness.) 
"     2.      "  Atonica,  (Atonic  green-sickness.) 

Gen.  IT.     Proeotia. 
Genital  precocity. 

Spec.   I.     P.  Masculina,  (Male  precocity.) 
"     2.       "  Feminina,  (Female  precocity.) 

Gen.  III.     LagnesiSy 
Lust. 

Spec.   I.     L.  Salacitas,  (Salacity.) 

"     2.      "  Furor,  (Lascivious  madness.) 

Gen.  IV.     Agenesiuy 
C  Male  sterility. 

Spec.  I.     A.  Impotens,  (Male  impotency.) 

"     2.      '*   Dyspermia,  (Seminal-mis-emission.) 
"     3.      *'    Incongrua,  (Copulative  incongruity.) 


good's  table  of  classification.        157 

Gen,    V.     Aphoria, 
Female  sterility,  Barrenness. 

Spec,  I.     A.  Impotens,  (Barrenness  of  impotency.) 
"     2.      *'   Paramenica,  (Barrenness  of  mis-men- 
struation.) 
"     3.      "■    Impercita,  (Barrenness  of   irrespon- 

dence.) 
"     4.      **    Incongrua,     (Barrenness    of     incon- 
gruity.) 

Gen.    VI.     Aedoptosis^ 
Genital  prolapse. 

Spec.  I.     A.  Uteri,  (Falling  down  of  the  womb.) 
"     2.      "    Vaginae,  (Prolapse  of  the  vagina.) 
"     3.      "   Vesicae,  (Prolapse  of  the  bladder.) 
"     4.       "    Complicata,     (Complicated     genital 

prolapse.) 
"     5.      "    Polyposa,  (Genital  excrescence.) 

Ord.  III.     Carpotica, 
Affecting  the  impregnation. 

Gen.  I.     ParacyesiSy 
Morbid  pregnancy. 

Spec.  I.     P.  Irritativa,     (Constitutional   derange- 
ment of  pregnancy.) 


158       good's  table  of  classification. 

Sp€c.  2.      "  Uterina,     (Local     derangement     of 

pregnancy.) 
"     3.      "■  Abortus,  (Abortion.) 

Gen.  II.     Parodynia^ 
Morbid  labour. 

P.  Atonica,  (Atonic  labour.) 

"  Implastica,  (Unpliant  labour.) 

'*  Sympathetica,  (Complicated  labour.) 

*'  Perversa,     (Preternatural     presenta- 

tion.) 
"  Amorphica,  (Impracticable  labour.) 
"  Pluralis,  (Multiplicate  labour.) 
"     7.      "  Secundaria,  (Sequential  labour.) 

Gen.  III.     Eccyesis, 
Extra-uterine-fetation. 

Sj)ec.   I.     E.  Ovaria,  (Ovarian  exfetation.) 
^'     2.      '*  Tubalis,  (Tubal  exfetation.) 
"     3.      *'  Abdominalis,  (Abdominal  exfetation.) 

Ge7t.  IV.     Pseudocyesis, 
Spurious  pregnancy. 

Spec.   I.     P.  Molaris,  (Mole.) 

"     2.      *'  Inanis,  (False  conception.) 


•yec. 

I. 

<< 

2. 

<< 

3. 

<< 

4. 

<( 

5. 

<4 

6. 

good's  table  of  classification.       159 

CLASS.  VI.     ECCRITICA, 

Diseases  of  the  excernent  function. 

Ord.  I.     Mesotica, 
Affecting  the  parenchyma. 

Gen.  I.     Polysarcia, 
Corpulency. 

Spec.   I.     P.  Adiposa,  (Obesity.) 

Ge7t.  II.     Emphyma^ 
Tumour. 

Spec.   I.     E.  Sarcoma,  (Sarcom.atous  tumour.) 
"     2.      "   Encystis,  (Encysted  tumour.) 
"     3.       "  Exostosis,  (Bony  tumour.) 

Gen.  III.     Parostia, 
Mis-ossilication. 

Spec.  I.     P.  FragiHs,  (Fragility  of  the  bones.) 
"     2.      "  Flexilis,  (FlexiHty  of  the  bones.) 

Gen.  IV.     Cyrtosis, 
Contortion  of  the  bones. 

Spec.   I.     C.  Rhachia,  (Rickets.) 
**     2.      "   Cretinismus,  (Cretinism.) 


i6o       good's  table  of  classification. 

Gen.    V.     Osthexia^ 
Osthexy. 

Spec.  I.     O.  Infarciens,       (Parenchymatous      os- 
thexy.) 
"     2.      "    Implexa,  (Vascular  osthexy.) 

Ord.  II.     Catotica, 
Affecting  internal  surfaces. 

Gen.  I.     HydropSy 
Dropsy. 

Spec.   I.  H.  Cellularis,  (Cellular  dropsy.) 

**     2.  *'    Capitis,  (Dropsy  of  the  head.) 

"•     3.  "■    Spinae,  (Dropsy  of  the  spine.) 

"     4.  "    Thoracis,  (Dropsy  of  the  chest.) 

"     5.  "    Abdominis,  (Dropsy  of  the  belly.) 

''     6.  "    Ovarii,  (Dropsy  of  the  ovaries.) 

"     7.  "   Tubalis,  (Dropsy   of    the   Fallopian 

tubes.) 

"     8.  "    Uteri,  (Dropsy  of  the  womb.) 

"     9.  "    Scroti,  (Dropsy  of  the  scrotum.) 

Gen.  II.     Emphysema^ 
Inflation,  Wind-dropsy. 

Spec.  I.     E.  Cellulare,  (Cellular  inflation.) 
"     2.      "  Abdominis,  (Tympany.) 


good's  table  of  classification.       i6i 

Gen.  III.     Paruriay 
Mismicturition. 

Spec.   I.  P.  Inops,  (Destitution  of  urine.) 

2.  "  Retentionis,  (Stoppage  of  urine.) 

3.  "  Stillatitia,  (Strangury.) 

4.  '*  Mellita,  (Saccharine  urine,  Diabetes.) 

5.  "  Incontinens,  (Incontinence  of  urine.) 

6.  "  Incocta,  (Unassimilated  urine.) 

7.  "  Erratica,  (Erratic  urine.) 

Gejt.  IV.     Lithia, 
Urinary  calculus. 

Spec.   I.     L.  Renalis,  (Renal  calculus.) 

"     2.      "   Vesicalis,  (Stone  in  the  bladder.) 

OrD.    III.      ACROTICA, 

Affecting  the  external  surface. 

Gen.  I.     EphidrosiSy 
Morbid  sweat 

E.  Profusa,  (Profuse  sweat.) 
'*  Cruenta,  (Bloody  sweat.) 
"  Partialis,  (Partial  sweat.) 
"  Discolor,  (Coloured  sweat.) 
''  Olens,  (Scented  sweat.) 
"  Arenosa^  (Sandy  sweat.) 


Spec. 

I. 

2. 

3. 

4- 

5. 

6. 

i62       good's  table  of  classification. 

Gen.  II.     ExanthesiSy 
Cutaneous  blush. 

Spec.  I.     E.  Roseola,  (Rose-rash.) 


Gen.  III.     Exorniiay 
Papulous  skin. 

Spec.   I.  E.  Strophulus,  (Gum-rash.) 
"     2.      "  Lichen,  (Lichenous-rash.) 

"     3.  "  Prurigo,  (Pruriginous-rash.) 
"     4.       "  Milium,  (Millet  rash.) 

Gen.  IV.     Lepidosis, 
Scale-skin. 

Spec.  I.  L.  Pityriasis,  (Dandriff.) 

"     2.  "  Lepriasis,  (Leprosy.) 

*'     3.  "  Psoriasis,  (Dry-scall.) 

"     4.  "  Icthyiasis,  (Fish-skin.) 

Gen.    V.     Ecphlysisy 
Blains. 

Spec.  I.  E.  Pompholyx,  (Water-blebs.) 

*'     2.  "  Herpes,  (Tetter.) 

"     3.  **  Rhypia,  (Sordid-blain.) 

"     4.  "  Eczema,  (Heat  eruption.) 


good's  table  of  classification.       163 

Gen.    VI.     Ecpyesis, 
Humid  scall. 

Spec.   I.  E.  Impetigo,  (Running  scall.) 

*'     2.  •*  Porrigo,  (vScabby  scall.) 

"     3.  "  Ecthyma,  (Papulous  scall.) 

"     4.  "  Scabies,  (Itch.) 

Gen.    VII.     Malis, 
Cutaneous  vermination. 

Spec.  I.  M.  Pediculi,  (Lousiness.) 
''     2.       •*    Pulicis,  (Flea-bites.) 
"     3.       "    Acari,  (Tick-bite.) 
**     4.       "    Filariae,  (Guinea  worm.) 
"     5.       "    Oestri,  (Gad-fly  bite.) 
"     6.       "    Gordii,  (Hair  worm.) 

Gen.    VIII     Ecphymay 
Cutaneous  excrescence. 

Spec.  I.  E.  Caruncula,  (Caruncle.) 

"     2.  *'    Verruca,  (Wart.) 

"     3.  "   Clavus,  (Corn.) 

"     4.  "    Callus,  (Callus) 

Gen.  IX.     Trichosis, 
Morbid  hair. 

Spec.   I.     T.  Setosa,  (Bristly  hair.) 
"     2.      "  Plica,  (Matted  hair.) 


1 64       good's  table  of  classification. 


spec.  3. 

4. 

5- 
6. 

7. 
8. 


Spec.   I 
2 

3 

4 

5 
6 


T.  Hirsuties,  (Extraneous  hair.) 
"  Distrix,  (Forky  hair.) 
"  Poliosis,  (Gray  hairs.) 
"  Athrix,  (Baldness.) 
"  Area,  (Areated  hair.) 
**  Decolor,  (Miscolored  hair.) 

Gen.  X.     EpichrosiSy 
Macular-skin. 

E.  Leucasmus,  (Weal-skin.) 

''  Spilus,  (Mole.) 

"  Lenticula,   (Freckles.) 

*'  Ephelis,  (Sun-burn.) 

'*  Aurigo,  (Orange-skin.) 

"  Poecilia,  (Pye-balled-skin.) 

"  Alphosis,  (Albino-skin.) 


Good's  classification  is  exhaustive  but  his 
nomenclature  very  fanciful.  The  following  are 
among  the  manv  blemishes  contained  in  his  sys- 
tem of  classification. 

Abscess  of  the  breast,  bubo,  and  gum-boil,  are 
placed  as  species  of  the  same  genus ;  sty  is  in  the 
same  genus  as  anthrax  ;  chilblain  with  erysipela- 
tous inflammation  ;  croup  with  peritonitis,  inflam- 
mation of  the  brain,  carditis,  nephritis,  cystitis, 
etc.  ;  gout  with  white  swelling ;  aphtha  with 
pemphigus  and  erysipelas ;  priapism   with   wry- 


ALIBERT.  165 

neck  and  locked-jaw,  etc.,  and  yet  Good  is  con- 
sidered as  the  greatest  of  all  classifiers. 

Alibert,  in  his  Nosologie  natiirelle  ou  les  maladies 
du  corps  humain  disiribiiees  par  fajnilles^  groups 
diseases,  in  accordance  with  the  organs  affected, 
into  certain  classes,  families  and  genera  as  fol- 
lows: 

First  class.  Trophopathies,  or  diseases  which 
attack  the  functions  of  assimilation. 

First  family.  Gastroses,  diseases  whose  princ- 
ipal seat  is  in  the  stomach  ;  thirteen  genera. 

Second  family.  Enteroses,  enteric  diseases ; 
ten  genera. 

Third  family.  Choloses,  diseases  of  the  biliary- 
apparatus  ;  eleven  genera. 

Fourth  family.  Uroses,  diseases  of  the  urinary 
appai'atus ;  twelve  genera. 

Fifth  family.  Pneumoses,  diseases  of  the 
respiratory  organs ;  eight  genera. 

Sixth  family.  Angioses,  diseases  of  the  cir- 
culatory system  ;  nineteen  genera. 

Seventh  family.  Leucoses,  diseases  of  the  se- 
rous and  lymphatic  system  ;  twelve  genera. 

Eighth  family.  x\denoses,  diseases  of  the  gland- 
ular system  ;  five  genera. 

Ninth  family.  Ethmoplecoses,  diseases  of  the 
cellular  tissuse  ;  six  genera. 


1 66  HOSACK,    RAIGE-DELORME. 

Tenth  family.  Blennoses,  diseases  of  the  mu- 
cous membranes ;  eleven  genera. 

This  system  of  nosography  does  not  appear  to 
have  been  completed. 

Doctor  Hosack's  system  consists  of  eight 
classes ;  twenty-five  orders ;  and  one  hundred 
and  ninety-eight  genera. 

The  Dictiomiaire  de  Medecine,  second  edition 
Paris  1841,  Volume  23rd,  p.  240,  contains  an 
article  with  the  heading  pathologie,  by  Raige- 
Delorme,  and  in  this  article  is  included  a  classi- 
fication of  diseases  which  is  here  reproduced  as 
an  example  of  the  decline  of  nosography  in  the 
country  of  its  birth. 

raige-delorme's  classification. 

CLASS  I.     General  diseases  whose  anatomical 
conditions  are  unknow^n. 

Order  i.     Pyrexiae. 

Genus  i.     Essential  pyrexiae. 

'*  2.  Pyrexiae  having,  besides  their  febrile 
phenomena,  certain  constant  an- 
atomical or  physiological  charac- 
ters. 

*'       3.     Exanthematic  pyrexiae. 

*^       4.     Symptomatic  pyrexiae. 


RAIGE-DELORME.  167 

Order  2.     General  cachaectic  diseases. 

(Tuberculosis,  melanosis,  and  the  divers 

degenerations.) 

CLASS  II.     Mixed  diseases. 
(General  and  local.) 

CLASS  III.     Local  diseases. 
Order  i.     Phlegmasiae. 

Order  2.     Haemorrhagiae. 

Order  3.     Diseases  which  result  in  degenera- 
tion of  the  tissues  ;    an  analogous  or  a 
heterologous    organic    production : 
tubercle,  cancer,  melanosis,  etc. 

Order  4.     Dropsies. 

Order  5.     Fluxes. 

Order  6.     Pneumatoses. 

CLASS  IV.     Neuroses. — Diseases  characterised 

by  a  trouble  in  the  functions  of  the  nervous 

system,  without  appreciable  textural 

lesions. 

The  different  genera  of  neuroses  are, 
Neuroses  of  the  cephalo-rhachidian  centres  ; 


l68         COMMENTS   ON   DELORME'S   SYSTEM. 

Neuroses  of  the  senses  ; 
Neuralgiae ; 

Neuroses  of  the  respiratory  organs  ; 
Neuroses  of  the  heart ; 
Neuroses  of  the  digestive  organs. 

CLASS  V.     Virulent  diseases. 
(Syphilis,  variola,  vaccinia.) 

CLASS  VI.     Poisoning. 
CLASS  VIL     Asphyxiae. 

CLASS  Vin.     Mechanical  or  Surgical  diseases^ 

This  comparatively  modern  classification  and 
its  nomenclature,  abound  in  the  greatest  inconsis- 
tencies and  inaccuracies,  and  in  the  most  flagrant 
violations  of  the  simplest  rules  of  classification 
and  nomenclature,  to  say  nothing  of  the  pathol- 
ogical inaccuracies  and  the  defective  definitions. 

The  name  of  the  first  class  is  objectionable  on 
account  of  its  length  and  obscurity.  The  author^ 
instead  of  naming  the  second  genus  of  the  first 
order  of  this  classs,  attempts  to  describe  it.  In 
the  second  order  of  the  first  class  he  mixes  tuber- 
culosis and  melanosis  with  the  ''  different  degen- 
erations "  and  repeats  them  in  the  third  order  of 


COMMENTS   ON   DELORME'S   SYSTEM.  1 69 

the  third  class.  The  second  class  is  as  objection- 
able as  the  first  class.  Among  the  orders  of  the 
third  class  are  jumbled  up,  phlegmasiae,  haemor- 
rhagiae,  dropsies,  fiuxes,  and  pneumatoses.  He 
defines,  and  inaccurately  too,  instead  of  naming, 
the  third  order  of  this  third  class. 

Taking  into  consideration  the  excellent  work, 
in  the  direction  of  arrangement,  performed  in 
France  for  more  than  a  century  prior  to  the  ap- 
pearance of  this  classification,  it  is  past  compre- 
hension that  so  inexact  and  unsatisfactory  a  classi- 
fication should  have  appeared  from  the  pen  of  a 
writer  in  the  great  medical  encyclopedia  of  a 
country  so  renowned  for  its  medical  talent. 

All  of  the  nosographers  so  far  mentioned  have 
enumerated  only  a  very  few  of  the  affections  of 
the  uro-genital  apparatus. 

A  number  of  other  nosographies  which  have 
more  or  less  merit  are  noticed  under  the  head  of 
bibliography. 


I/O 


WILLIAMS. 


As  pertinent  to  the  subject,  Doctor  Williams' 
tabular  arrangement  of  structural  diseases  or 
diseases  of  nutritition  is  here  reproduced  from 
the  American  edition  of  his  work  published  in 
the  year  1853.* 

Increased. — Hypertrophy- 
Diminished. — Atrophy 

Induration 

Softening 

Transformation 


3 
m 


il\ 


Contraction 

Dilatation 

Obstruction 

Compression 

Displacement 

Rupture,  etc. 


tr. 

O 

a, 
Q 


Euplastic 


Cicatrices 

False  membranes 


f  Cirrhosis 
^         1     .•       Fibro-cartilajje 

i  CaCOplaStlC^   r.r^v  tnh^rrlS 


o 

O 


i 


Aplastic 

Non- 
malignant 

Malignant 


I  Gray  tubercle 
[  Atheroma,  etc. 

^  Yellow  tubercle 
I  Calareous  matter, 

etc. 
(  Cysts 
^  Tumors 
(  Hydatids,  etc. 

C  Carcinoma 
<  Encephaloma 
I  Melanosis,  etc. 


*  Principles  of  medicine,  etc.,  by  Charles  J.  B.  Williams, 
M.  D.,  F.  R.  S.  etc.  American  edition  by  Meredith  Clymer, 
M.  D.,  Philadelphia  1853.  The  American  editor  has  contrib- 
uted much  to  exact  nomenclature,  particularly  in  his  writings 
of  the  last  twenty  years. 


AITKEN  171 

ON  THE   PRINCIPLES   OF   CLASSIFICATION. 

Sir  William  Aitken,  in  his  "  Science  and 
Practice  of  Medicine,"  third  edition,  published 
in  London  in  the  year  1864,  under  the  head 
**  Principles  of  Classification,"  says  : 

"  Many  systems  of  nosology  have  been  adopted 
from  time  to  time  ;  and  as  valuable  general  prin- 
ciples have  been  adduced  from  some,  the  grounds 
on  which  diseases  have  been  classified  may  be 
briefly  described  under  the  following  nine  heads . 

"  I.  The  nature  of  the  ascertained  causes  of 
disease.  On  this  principle  two  classes  of  dis- 
eases are  recognised:  (i,)  Diseases  arising  from 
general  causes  ;  (2,)  Diseases  arising  from  specific 
causes. 

"  II.  The  pathological  states  and  conditions 
which  attend  diseases.  The  principle  of  this 
classification  consists  in  determining  alterations 
of  the  structure  or  the  chemical  composition  of 
parts,  from  which  names  are  given  to  the  dis- 
ease   

"  III.  The  properties,  powers,  or  functions  of 
an  organ  or  system  of  organs  being  deranged, 
dictates  a  classification  in  which  the  most  prom- 
inent effects  or  phenomena  of  morbid  states  are 
considered  as  the  disease 

*'  IV.  The  diseases   comprehended  under   the 


172  AITKEN. 

two  latter  principles  of  classification  are  some- 
times inaccurately  and  loosely  brought  together 
under  the  heads  of  structural  and  functional  dis- 
eases. The  diseases  of  function,  for  instance,  be- 
ing made  to  embrace  the  neuroses,  haemorrhages, 
and  dropsies;  while  inflammation,  tubercle,  can- 
cer, melanosis,  hypertrophy  and  atrophy  are  the 
subordinate  classes  of  the  diseases  of  structure. 

"  V.  A  basis  of  classification  has  been  adopted, 
founded  on  the  pathological  nature  of  the  dif- 
ferent morbid  processes,  but  the  arrangement  of 
the  orders  and  subdivisions  is  determined  by  the 
anatomical  arrangement  of  the  textures  and  or- 
gans of  the  animal  hody,  as  originally  developed 
by  Bichat. 

"  VI.  A  ground  of  classification  exists,  having 
reference  to  the  general  nature  and  localisation 
of  the  morbid  states.  It  comprehends  three 
classes:  (i,)  Diseases  which  occupy  the  whole 
system  at  the  same  time,  and  in  which  all  the 
functions  are  simultaneously  deranged.  These 
have  been  named  general  diseases,  such  as  fevers ; 
(2,)  Constitutional  affections,  meaning  thereby 
diseases  which  display  themselves  in  local  lesions 
in  any  part  but  not  in  all  parts  at  the  same  time — 
e.g.,  rheumatism,  gout ;  (3,)  Local  morbid  pro- 
cesses. 

"VII.  Applying   the    principles    of    a   purely 


SAVIGNAC,    STARK.  1/3 

humoral  pathology,  we  have  a  classification  con- 
sisting of — a.  Fevers  ;  b.  Dyscrasiae — e.  g.,  tabes, 
chlorosis,  scorbutus,  dropsy,  diabetes,  pyaemia, 
tuberculosis,  carcinoma ;  c.  Constitutional  dis- 
eases, induced  by, — (i,)  specific  agents,  (2,)  veget- 
able substances. 

*'  Such  is  Wunderlich's  arrangement  of  dis- 
eases (1852). 

"  VIII.  Mr.  de  Savignac,  Professor  of  Clinical 
Medicine  at  the  Naval  School  of  Toulon,  has  re- 
cently (1861)  propounded  a  nosological  arrange- 
ment (which  he  considers  a  natural  one)  founded 
on  what  he  believes  to  be  the  '  elements  '  of  dis- 
ease. His  so  called  elements  seem  to  be  vague 
general  expressions,  or  names  to  denote  the  lead- 
ing phenomena  of  diseases  or  the  unknown  cause 
of  such  phenomena 

"  IX.  Doctor  Stark,  of  Edinburgh,  has  recently 
(1864)  proposed  an  arrangement  embracing  six- 
teen classes:  (i,)  Fevers;  (2,)  Diseases  of  the 
brain,  etc,  ;  (3,)  Diseases  of  the  heart  and  organs 
of  circulation;  (4,)  Diseases  of  the  organs  of 
respiration  ;  (5,)  Diseases  of  the  organs  of  diges- 
tion ;  (6,)  Diseases  of  the  urinary  organs ;  (7,) 
Diseases  of  the  organs  of  generation  ;  (8,)  Dis- 
eases of  the  organs  of  locomotion  ;  (9.)  Diseases 
of  the  skin  and  cellular  tissue  ;  (10,)  Diseases  of 
uncertain  seat ;  (11,)  Malformation  ;  (12,)  Debility 


1/4  STARK,   FARR. 

at  birth,  and  premature  birth;  (13,)  Old  age; 
(14,)  Sudden  deaths;  (15,)  Violent  or  unnatural 
deaths  ;  (16,)  Causes  not  specified 

" Classification    conducted    on   the    plan 

proposed  by  Doctor  Stark  is  inconsistent  with 
any  intelligible  principle  of  arrangement. 

"  None  of  these  nine  principles  of  classification 
lead  to  a  perfectly  philosophical  or  purely  nat- 
ural classification,  because  diseases  are  not  yet 
sufficiently  understood  to  permit  us  to  see  clearly 
their  mutual  relations  ;  and  the  best  recommend- 
ation of  any  one  of  them  would  be  a  negative 
one — namely,  that  of  doing  the  least  possible  vio- 
lence to  our  imperfect  knowledge  regarding  the 
natural  affinities  or  alliances  of  diseases,  of  which 
we    have   at   present   only   a   sort  of  instinctive 


recognition 

The  system  adopted  by  Sir  W.  Aitken  in 
nearly  all  the  editions  of  his  work  is  that  of 
Doctor  William  Farr,  and  consists  of  five  classes 
as  follows:  (i,)  Zymotic  diseases,  four  orders; 
(2,)  Constitional  diseases,  two  orders  ;  (3,)  Local 
diseases,  eleven  orders  ;  (4,)  Developmental  dis- 
eases, four  orders  ;  (5,)  Lesions  from  violence 
tending  to  sudden  death,  six  orders.  In  all 
twenty-seven  orders. 

Doctor  Farr's  system,  says  Sir  W.  Aitken, 
was  discussed  at  several  meetings  of  the  statist- 


ROYAL   COLLEGE   OF   PHYSICIANS.  1 75 

ical  congress  of  the  European  nations,  in  Paris 
(1855),  ^"d  in  Vienna  (1857),  where  a  nomen- 
clature similar  to  the  English  was  adopted,  but 
no  definite  classification  was  agreed  upon. 

LABORS  OF  THE  ROYAL  COLLEGE  OF 
PHYSICIANS  OF  LONDON. 

A  joint  committee,  of  which  Doctor  William 
Farr  was  a  member,  appointed  by  the  Royal 
College  of  Ph3'sicians  of  London  to  draw  up  a 
nomenclature  of  diseases,  published  its  first  re- 
port in  the  year  1869,  after  more  than  ten  years 
of  labor.  In  this  report,  one  thousand  one  hun- 
dred and  forty-six  diseases  are  enumerated,  ex- 
clusive of  human  parasites  of  which  fifty-five  are 
counted.  The  committee  very  properly  offered 
this  nomenclature  as  only  provisional  and  sug- 
gested that  it  be  subjected  to  decennial  revisions. 
The  main  object  of  the  work,  as  set  forth  in  the 
preface,  was  to  lay  "  the  foundation  for  a  nomen- 
clature of  diseases  in  any  language  extant  on  the 
earth." 

This  nomenclature  has  been  reprinted  by 
order  of  the  chief  of  the  United  States  Marine 
Hospital  Service,  in  1874,  and  a  few  years  ago  a 
part  of  the  first  decennial  revision  was  printed  by 
order  of  the  New  York  State  Board  of  Health. 


1/6  AMERICAN   MEDICAL   ASSOCIATION. 

In  the  year  1869  the  American  Medical  Asso- 
ciation appointed  a  committee  "to  determine 
what  alterations,  if  any,  are  necessary,  to  adapt 
the  Provisional  Nomenclature  of  the  Royal  Col- 
lege of  Physicians  of  London  to  general  use  in 
the  United  States."  This  Committee  reported, 
in  1870,  **  that  the  English  nomenclature  was  not 
adapted  to  this  end,  and  recommended  the  ap- 
pointment of  a  new  committee  to  prepare  a 
nomenclature  of  their  own."  The  new  commit- 
tee was  appointed  with  Dr.  Francis  Gurney 
Smith,  as  Chairman  and,  in  1872,  presented  its 
report  and  nomenclature,  based  upon  the  English 
system.  A  minority  report  was  then  submitted  to 
the  Association.  Both  reports  were  accepted,  but 
only  the  following  resolution,  appended  to  the 
minority  report  was  adopted. 

**  Resolved,  That  the  Nomenclature  and  classi- 
fication just  submitted  by  the  committee  be  pub- 
lished in  the  Transactions ;  that  one  thousand 
extra  copies  be  printed  in  pamphlet  form  and 
distributed  to  the  profession,  and  that  the  ques- 
tion of  the  adoption  of  the  proposed  Nomencla- 
ture and  classification  by  this  body  be  postponed 
till  the  next  annual  meeting." 

The  extra  copies  of  the  nomenclature  v/ere  dis- 
tributed in  accordance  with  the  resolution  offered 
by   the   minority  of   the  committee,  and  at  the 


ROYAL  COLLEGE   OF   PHYSICIANS.  1 7/ 

next  annual  meeting  (1873)  of  the  Association  a 
majority  report  was  again  presented.  But  it 
was  urged  that  the  American  nomenclature  was 
inferior  to  the  English  and  after  some  discussion, 
the  following  resolutions  were  adopted. 

*'  Resolved,  That  in  the  opinion  of  this  Asso- 
ciation, it  is  inexpedient  to  adopt  the  nomencla- 
ture and  classification  presented  by  the  majority 
of  the  committee  on  nomenclature  at  the  meeting 
in  Philadelphia." 

"  Resolved,  That  a  committee  of  three  be  ap- 
pointed by  the  President,  whose  duty  it  shall  be 
to  communicate  the  foregoing  resolution  to  the 
proper  committee  of  the  Royal  College  of 
Physicians  of  London,  and  to  negotiate  for  the 
representation  of  the  American  Medical  Associa- 
tion in  the  first  decennnial  revision  of  their 
nomenclature." 

The  committee  was  duly  appointed,  but  has 
never  made  any  report. 

In  the  second  edition  of  the  official  nomencla- 
ture of  the  Royal  College  of  Physicians  of  Lon- 
don (1885),  it  seems  as  though  the  committee  had 
failed  to  take  advantage  of  many  of  the  medical 
advances  of  the  decade,  for,  aside  from  the  viola- 
tions of  established  principles  of  nomenclature 
and  classification  which  it  contains,  much  of  the 


178  THE  DERMATOLOGISTS. 

old  medical  terminolog-y  is  retained,  and  many 
symptoms  are  still  classed  as  diseases. 

It  is  needless  to  indulge  in  any  extended  crit- 
icism of  this  new  nomenclature,  since  it  has  al- 
ready been  so  fairly  and  exhaustively  reviewed. 
The  reader  is  therefore  referred  to  the  excellent 
critical  analysis  of  the  London  nomenclature  by 
Doctor  A.  Rabagliati,  of  Bradford,  England. 
This  review,  which  is  well  worthy  of  the  most 
careful  study,  first  appeared  in  the  *'  Medical 
Press  and  Circular,"  and  then  in  book  form.* 

The  dermatologists  have  contributed  largely 
to  systematic  arrangement  for  a  century  past. 
Their  bibliography  begins  with  the  nomenclature 
of  Celsus,  of  Mercurialis  (1572),  and  of  Riolan 
(1610),  from  which  they  trace  their  systematic  ar- 
rangement of  dermatoses  down  to  Auspitz  f 
(1881)   and    Bronson  X   (1884    and    1887).     Their 


*  Some  remarks  on  the  classification  and  nomenclature  of 
diseases,  by  A.  Rabagliati,  M.  A.,  M.  D.,  reprinted  from  the 
Medical  Press  and  Circular. — London,  Bailliere,  Tyndall,  and 
Cox.  1886. 

t  For  a  very  extended  dermatographical  bibliography,  and 
synopsis  of  divers  systems,  see  Auspitz'  system  der  Haut- 
krankheiten,  Vienna  1881. 

I  E.  B.  Bronson.  The  objects  of  dermatological  classifica- 
tion, with  especial  reference  to  Auspitz'  system.  Journal  of 
cutaneous  and  venereal  diseases.  Vol.  II,  June  1884. 


THE  DERMATOLOGISTS.  1/9 

work  however  requires  a  very  extensive  revision, 
if  not  an  entire  reconstruction. 

The  preceding  outline  of  the  history  of  noso. 
graphy,  and  of  the  synopses  of  a  few  of  the  old 
systems,  is  here  given  with  the  view  of  placing 
the  reader  in  possession  of  the  methods  of  the 
nosogfaphers  in  a  compact  form,  in  order  that  he 
may  see  almost  at  a  glance  the  defects  of  the  early 
essays  and  compare  them  with  the  modern  sys- 
tems before  he  contributes  his  share  to  the  im- 
provement of  this  science. 

A  few  of  the  nosographers,  to  whose  labors 
allusion  has  been  made  in  the  historical  outline 
have  worked  with  great  fidelity  and  earnestness 
for  the  improvement  of  this  science,  while  the 
great  majority  have  simply  copied  their  prede- 
cessors and  reproduced  their  most  obvious  errors 
without  the  least  attempt  at  correction. 

Some  of  the  rules  formulated  by  the  early  writ- 
ers are  appended  to  this  history. 


E.  B.  Bronson.  A  study  of  the  considerations  relating  to 
the  classification  of  skin  diseases  with  an  attempt  to  construct 
a  logical  system  in  accordance  with  fundamental  principles  of 
etiology.  Pamphlet,  pp.  19.  Reprinted  from  the  Journal  of 
cutaneous  and  genito-urinary  diseases.     October  1887. 


i8o 

RULES  FOR  THE  GUIDANCE  OF  THE 
NOSOGRAPHER. 

The  following  rules,  for  the  guidance  of  noso- 
graphers,  laid  down  by  Cullen,  Parr,  Linnaeus 
and  Young,  are  given  in  full  because  of  their 
general  excellence  and  because  they  illustrate  so 
well  the  principles  of  nomenclature  and  classi- 
fication, besides  carrying  with  them  the  authori- 
tative weight  of  these  eminent  men  who  labored 
with  so  much  ardor  for  the  advancement  of  noso- 
graphy. 

Cullen's  nosography  appeared  in  the  year  1769. 
He  therefore  had  the  benefit  of  the  experience 
of  Sauvages,  Linnaeus  and  Vogel.  He  endeav- 
ored to  improve  upon  them,  and  formulated  cer- 
tain rules  for  distinguishing  genera,  species,  and 
varieties.  These  rules  are  here  reproduced,  al- 
though some  of  them  do  not  now  possess  the 
value  which  they  may  have  had  at  the  time  of 
their  publication.* 

cullen's  rules  for  distinguishing 

GENERA,   species   AND   VARIETIES. 

I.  "Those  who  have  turned  their  attention  to 
this  subject  hitherto,  have  not  I  think  proceeded 
with  due  consideration.    They  have  gone  at  once 


*  Edinburgh  edition  1800. 


cullen's  rules.  i8i 

to  constitute  the  principal  genera  of  the  classes 
and  orders,  without  sufficiently  attending  to  the 
species  of  diseases.  Now  nature  has  made  noth- 
ing but  species ;  the  structure  of  genera  is  an  ef- 
fort of  the  human  mind,  v/hich,  till  the  species 
are  well  known  and  understood,  must  be  falla- 
cious and  uncertain  ;  and  indeed,  in  constituting 
genera,  unless  we  have  perpetual  reference  to 
the  species,  all  our  labor  will  prove  futile  and 
vain. 

2.  "  It  is  certainly  a  very  difficult  thing  in 
nosology  to  say  what  is  a  true  species,  or  what  is 
only  a  variety ;  as  those  marks  which  serve  to 
distinguish  species  from  varieties  in  zoology  and 
botany,  are  not  to  be  found  in  diseases.  I  there- 
fore considered  it  as  safest  and  even  necessary  to 
enumerate  many  varieties.  And  as  I  esteem  such 
a  distinction  very  useful  in  practice,  I  have  every- 
where endeavored  to  make  it :  not  always  indeed 
with  equal  certainty,  but  often,  at  least,  with 
some  degree  of  probability. 

3.  "  When  any  disease,  under  Avhich  several 
men  labour,  exhibits,  in  each  individual,  all  the 
symptoms  that  characterise  a  certain  species,  I 
would  not  consider  that  these  were  different 
species,  because  the  symptoms  prevailed  in  one 
patient  in  a   greater  or  less  degree,  than  in  an- 


i82  cullen's  rules. 

other.  And  I  am  of  opinion  that  diseases  which 
differ  only  in  a  degree,  constitute  merely  varieties 
of  a  certain  species. 

4.  "  Accordingly  in  distinguishing  a  variety 
from  a  species,  there  is  only  room  for  doubt 
when,  in  the  diseases  of  different  persons,  any 
symptoms  are  wanting  which  generally  accom- 
pany a  species,  or  when  others  are  present. 

5.  "  When  any  of  the  usual  symptoms  are 
wanting ;  and  we  can  distinguish  between  those 
that  are  more  and  those  that  are  less  essential,  1 
consider  the  absence  of  such  symptoms  as  indica- 
tive of  a  variety  only. 

6.  '*  When  to  the  characteristic  symptoms, 
others  are  added,  which  can  be  reckoned  the 
symptoms  of  symptoms,  rather  than  the  symp- 
toms of  the  cause,  they  constitute  only  a  variety. 

7.  **  Again,  when  these  additional  symptoms 
are  quite  unusual,  while,  at  the  same  time,  the 
principal  circumstances  of  the  disease  are  little 
or  not  at  all  changed  ;  these  too  afford  only  a 
variety. 

8.  "  When  any  genus  of  disease  may  arise  from 
different  causes,  the  diversity  of  the  cause  may 
occasion  likewise  diversity  in  the  species,  though 
not  always  ;  for  when  the  difference  is  small,  and 
the  symptoms  at  the  same  time  are  little  affected 


cullen's  rules.  185 

by   it,    that    difference    will    constitute    only   a 
variety. 

9.  "A  genus  of  disease  may,  in  the  same  man-^ 
ncr,  produce  different  species,  according  to  the 
diversity  of  its  seat;  but  as  often  as  the  seat  is 
different,  while  there  is  no  difference  either  with 
respect  to  the  structure  of  the  part  or  Jts  func- 
tions, this  diversity  of  seat  can  only  indicate  a 
variety." 

In  the  edition  of  1827,  Cullen  remarks,  that  in 
nosology,  by  beginning  with  the  characters  of  the 
class,  and  from  thence  descending  to  orders  and 
genera,  the  term  genus  has  been  very  universally 
applied  to  species,  and  that,  by  imitation,  he  had  . 
been  led  to  do  the  same  thing,  for,  of  the  one  hun- 
dred and  thirty  three  genera  which  he  had  estab- 
lished in  his  first  edition,  a  hundred  are  properly 
species,  and  admit  of  no  farther  division  except 
into  varieties.  He  further  said,  "the  characters 
of  diseases  are  formed  by  a  concourse  of  various 
symptoms,  every  particular  of  which,  in  the 
language  of  methodical  writers,  is  a  nota  or 
mark :  now,  in  forming  the  character,  the  first, 
and  the  most  important  rule  is,  that  these  marks 
should  be  neither  more  nor  fewer  than  are  ab- 
solutely necessary.  If  we  have  more,  we  pass 
from  characters   or   definitions  to  descriptions  ; 


i84  cullen's  rules. 

Ave  leave  persons  in  doubt  when  they  find  a  dis- 
ease with  the  strictly  essential  character,  by  add- 
ing other  circumstances  which  they  may  suppose 
to  be  equall}^  necessary.  The  nosologists  have 
been  faulty  in  giving  both  superfluous  and  de- 
ficient characters. 

"  A  second  rule  is,  that  the  marks  which  we 
employ  should  be  sufficiently  evident,  and  if  pos- 
sible, constantly  present  at  every  period  of  the 
disease,  these  at  least  (that)  are  the  most  charac- 
teristic. Nosologists  transgress  against  this  rule 
when  the  marks  are  taken  from  the  duration, 
and  much  more  from  the  event  of  the  disease. 
To  affirm  that  a  disease  is  a  fatal  one,  is  indeed  a 
part  of  its  history,  but  cannot  serve  as  a  charac- 
ter when  we  first  view  the  disease. 

"  The  third  rule  is,  that  the  notae  chosen 
should  be  expressed  in  clear  and  very  intelligible 
terms,  and,  if  possible,  in  terms  the  meaning  of 

which    is   already   fixed    in   science The 

want  of  due  precision  of  language  affects  many 
parts  of  all  our  systems.  It  is  well  known,  that 
the  want  of  precision  in  the  use  of  terms  for  a 
long  time  retarded  the  perfection  of  botany  ;  and 
it  has  been  the  greatest  merit  of  Linnaeus,  that 
he  gave  much  more  precision,  and  a  determined 
meaning  to  almost  every  word  employed  in  that 


parr's  rules.  185 

science,  which  he  did  by  forming  a  delineato 
J)lantae,  by  fixing  a  term  for  every  part  of  a 
plant,  and  for  all  the  circumstances  in  which 
these  parts  can  vary.  But  we  will  not  bring 
nosology  to  a  good  condition  till  something  of 
the  same  kind,  a  delineatio  morbi,  be  attempted, 
which  ought  to  consider  all  the  symptoms  that 
-enter  into  a  specific  character  in  another  view 
than  that  taken  by  the  pathologists,  who  only 
trace  them  to  their  causes.  Here  we  ought  to 
•examine  the  symptoms  more  minutely  with  re- 
spect to  the  variety  of  their  appearance,  and  affix 
terms  to  them  accordingly. 

"  The  fourth  rule,  is  that  the  characters  should 
be   absolutely    free    and    independent   from    all 

theory   and    hypothesis Every    species 

ought  to  have  the  character  of  its  genus ;  and  in 
naming  or  distinguishing  species, it  is  sup- 
posed sufficient  merely  to  name  the  genus,  and 
to  add  such  marks  as  distinguish  the  species." 

parr's  rules. 

Under  the  head  of  classification  Dr.  Parr  says : 
I.  "It   is   said    that   nature  has   created    only 
species  :    it  is  not  true  ;  for  she  has  created  only 
individuals.     The   similarity  of   these  has    occa- 
sioned the  establishment  of  species.     Individuals, 


i86  parr's  rules. 

differing  in  circumstances  arising  from  accident ; 
in  plants  and  animals,  from  soil  and  climate  ;  in 
diseases,  from  constitution  ;  in  minerals,  from  lo- 
cality,  are  styled  varieties ;  and  these,  when  cir- 
cumstances are  changed,  return  to  the  species 
from  which  they  started.  These  distinctions,, 
though  apparently  simple  and  obvious,  are  how- 
ever, necessary  ;  for  naturalists  have  usually  be- 
gun at  the  other  extremity,  and  formed  '  meth- 
ods,' classes,  and  orders  before  they  have  estab- 
lished species  and,  at  this  moment,  in  nosology 
and  mineralogy,  the  greatest  impediments  to  im- 
provement arise  from  the  uncertainty  of  what 
are  species.  Even  in  botany  this  difficulty  was 
once  so  great,  that  more  than  half  of  Tourne- 
fort's  supposed  species  have  been  found  to  be 
varieties  only.  Three-fourths  of  Sauvages'  species 

of  diseases  are  varieties  or  symptoms.* 

2.  "  This  is  the  first  step  in  arrangement ;  for 
the  establishment  of  species  consists  in  ascertain- 
ing identity ;  of  genera  similarity.  A  striking 
discriminating  mark,  in  many  species,  sometimes 


*  The  criticism  made,  by  Dr.  Parr  of  Sauvages'  species  of 
diseases,  three  quarters  of  a  century  ago,  will  apply,  to  a  very 
great  extent,  to  the  two  editions  of  the  modern  English 
nomenclature,  for  they  both  include  many  symptoms  classed 
as  diseases. 


parr's  rules.  187 

establishes  a  genus  ;  at  others,  a  general  similar- 
ity. The  conduct  of  botanists,  however,  has  dif- 
fered in  this  part  of  their  labor,  from  the  differ- 
ence of  their  dispositions.  Some  naturalists^ 
catching  hastily  at  analogies,  have  included  nu- 
merous species  under  a  genus  :  others  more  wary 
and  exact,  have  retrenched  them  too  rigorously. 
The  latest  botanists  have  rendered  the  genera 
more,  sometimes  too,  numerous  ;  but  this  of  the 
two  is  the  more  venial  error,  since  new  dis- 
coveries continually  enlarge  them. 

3.  "  An  order  is  an  association  of  genera  ;  but 
orders  are  usually  too  comprehensive,  including^ 
too  great  a  number  of  genera  ;  and  to  facilitate 
investigation,  these  are  often  divided  into  sepa- 
rate groups,  as  in  mineralogy  the  species  are 
sometimes  divided  into  sub-species.  Each  is  a 
proof  of  imperfection  in  arrangement. 

4.  "A  class  contains  the  different  orders;  and 
though  in  reality,  it  should  be  the  last,  or  nearly 
the  last,  labourer,  it  has  usually  been  the  first ; 
and  to  make  the  system  elegant  in  appearance^ 
the  classes  have  been  few  and  comprehensive." 


-1 88 

APHORISMS     RELATING     TO    CLASSIFICATION, 
TAKEN   CHIEFLY   FROM   THE 
PHILOSOPHIA   BOTANICA    OF   LINNAEUS, 
BY   DOCTOR   THOMAS   YOUNG. 

Of  generic  characters. 

1.  *'  The  foundation  of  methodical  science  con- 
sists of  two  parts,  arrangement  and  nomenclature. 

2.  ''Arrangement  is  either  theoretical,  relating 
to  classes,  orders,  and  genera,  or  practical,  relat- 
ing to  species  and  varieties. 

3.  "  Arrangement  or  method  is  either  synop- 
tical or  systematic. 

4.  *'  A  synopsis  depends  on  arbitrary  divisions 
proceeding  in  pairs  at  each  step,  and  is  not  ad- 
missible in  botany,  except  as  a  key  or  index. 

5.  '*  A  system  proceeds  in  its  arrangement  by 
five  steps  ;  classes,  orders,  genera,  species,  and 
varieties. 

6.  "System  is  the  Ariadnean  thread,  without 
which  all  is  confusion. 

7.  ''  Species  m  natural  history  are  supposed  to 
have  been  originally  created  distinct. 

8.  '"■  Varieties  may  be  as  numerous  as  the  in- 
dividuals which  have  been  produced. 

9.  "  Genera  are  determined  in  botany  from  the 
agreement  of  the  parts  of  fructification. 


LINNAEUS   AND    YOUNG.  1 89 

10.  '*  Classes  are  deduced  from  the  regular 
agreement  of  many  genera,  in  the  parts  which 
characterise  them. 

11.  "An  order  is  a  subdivision  of  a  class,  in-^ 
tended  for  convenience. 

12.  **  Species  and  genera  depend  on  nature  ; 
varieties  often  on  cultivation  ;  classes  and  orders 
on  a  combination  of  nature  and  art. 

13.  '*  Habit  is  a  general  agreement  in  growth 
and  appearance. 

14.  "  Habit  is  to  be  silently  consulted  in  form- 
ing genera,  but  must  not  and  cannot  be  de- 
scribed. 

15.  "No  positive  rules  can  be  laid  down  re^ 
specting  identity  of  genus. 

16.  "  Few  genera  are  without  some  cases  of 
accidental  deviation. 

17.  "  Each  genus  is  commonly  characterised  by^ 
some  decided  singularity  of  form. 

18.  "Genera  thus  marked  must  be  kept  dis-^ 
tinct  or  united  accordingly. 

19.  "  The  more  constant  the  mark  in  different 
species,  the  better  distinction  it  affords. 

20.  "  Different  parts  are  the  most  constant  in 
different  genera  ;  but  scarcely  any  part  is  ever 
wholly  invariable. 


190  APHORISMS   OF   LINNAEUS 

21.  **  A  generic  character  is  the  definition  of  a 
genus,  and  may  be  of  three  kinds,  factitious,  es- 
sential, or  natural. 

22.  "  An  essential  character  affords  a  singular 
and  appropriate  criterion  of  the  genus.  Its  ex- 
cellence depends  on  its  brevity. 

23.  *'  A  factitious  character  distinguishes  the 
genus  only  from  others  of  the  same  artificial 
order. 

24.  "  A  natural  character  contains  everything 
remarkable  that  is  found  in  all  the  species  of  the 
genus.  It  may  often  require  alteration  when  new 
species  are  discovered. 

25.  ''A  factitious  character  is  a  substitute  for 
an  essential  one,  which  is  always  the  best  when 
it  can  be  obtained.  A  natural  character  is  a  work 
of  great  labor,  but,  when  completed,  it  is  the 
basis  of  all  systems,  the  guardian  of  genera,  and 
is  applicable  to  every  correct  and  practicable 
mode  of  arrangement. 

26.  "No  character  can  be  infallible  unless  it 
has  been  compared  with  all  the  species  of  the 
genus. 

27.  "  A  generic  character  must  not  contain 
comparisons,  except  with  things  perfectly  well 
known. 

28.  "  The  character  must  be  expressed  in  se- 


AND    YOUNG.  I9I 

lect,  accurate,  distinct,  and  compendious  terms, 
sufficient  in  number,  but  not  superfluous. 

29.  "The  character  must  remain  invariable  in 
every  possible  system  that  can  be  adopted.  With 
this  precaution,  the  introduction  of  a  new  system 
is  no  misfortune. 

30.  "  A  genus  may  consist  of  a  single  species, 
although  it  more  usually  contains  several  species. 

31.  "  What  is  established  respecting  the  charac- 
ters of  genera  must  be  understood,  with  some 
latitude,  of  those  of  classes. 

32.  "  Classes  are  more  arbitrary  than  genera, 
orders  than  either. 

33.  "  The  more  naturally  classes  are  established 
the  better. 

34.  '*  Great  difficulty  arises  from  the  excessive 
length  or  number  of  classes  and  orders. 

35.  ''Genera  which  are  allied  to  each  other 
ought  to  stand  together. 

Of  names. 

36.  "  He  who  establishes  a  new  genus  is  bound 
also  to  give  it  a  name. 

37.  "  A  generic  name  must  be  decided  on  be- 
fore  a  specific  one  is  formed. 


192  APHORISMS   OF   LINNEAUS 

38.  "  No  man  in  his  senses  would  employ  a 
generic  name  destitute  of  etymological  meaning. 

39.  "  Generic  names  consisting  of  two  entire 
and  separate  words  are  prohibited. 

40.  "  Generic  names  consisting  of  two  Latin 
words  united  together  are  scarcely  to  be  tol- 
erated. Such  compounds  of  Greek  origin,  on 
the  contrary,  are  elegant. 

41.  "  Generic  names  of  hybrid  origin,  for  in- 
stance partly  Greek  and  partly  Latin,  are  to  be 
rejected. 

42.  "  Generic  names  including  other  generic 
names  are  unworthy  of  a  scientific  nomenclature. 

43.  "  Generic  names  ending  in  oides  are  pro- 
hibited. 

44.  '*  Generic  names  derived  from  others  by 
the  addition  of  a  sjdlable  are  disapproved. 

45.  *'  Generic  names  very  nearly  resembling 
each  other  are  likely  to  cause  confusion. 

46.  ''  Generic  names  not  derived  from  Greek 
or  Latin  are  forbidden. 

47.  ''  Generic  names  common  to  natural  history 
and  anatomy,  pathology,  therapeutics,  or  the 
arts,  are  to  be  avoided.  (Thus  lichen  must  not 
be  a  genus  of  diseases  :  and  I  have  been  obliged 
to  change  the  name  spiloma  into  spilosis,  having 


AND   YOUNG.  I93 

found  that  the  botanists  had  taken  possession  of 
this  too.) 

48.  '*  Generic  names  contradicting  the  proper- 
ties of  some  of  the  species  are  bad. 

49.  "  Generic  names  must  not  be  identified  with 
those  of  natural  classes  or  orders. 

50.  "  Diminutives  and  derivatives  of  a  similar 
nature  are  allowable  as  generic  names.  (The 
diminutives  of  other  generic  names  are  however 
scarcely  admissible.) 

51.  "  Adjectives  are  inferior  to  substantives  as 
generic  names. 

52.  "  Generic  names  which  have  already  been 
employed  are  to  be  preferred  where  it  can  be 
done  without  inconvenience.  (Sometimes  how- 
ever it  is  better  to  employ  a  new  term  than  to 
alter  materially  the  application  of  an  old  one.) 

53.  "  Such  generic  names  as  express  an  essen- 
tial character  or  habit  are  the  best. 

54.  "An  ancient  name  should  be  employed  for 
a  genus  long  established. 

55.  "A  good  name  once  established  ought  not 
to  be  changed,  even  for  a  better  or  more  ancient 
one. 

56.  "  If  a  genus  is  to  be  divided,  the  old  name 


194  APHORISMS   OF   LINNAEUS 

must    remain    attached    to    the    most    common 
species. 

57.  "  Generic  names  are  to  be  written  in  Latin 
letters,  the  Greek  letters  being  expressed  accord- 
ing to  the  established  custom. 

58.  ''The  sounds  of  generic  names  are  to  be 
softened  as  much  as  possible. 

59.  *'  Long  and  harsh  names  are  to  be  avoided. 
Names  should  scarcely  exceed  twelve  letters. 

60.  "  Terms  of  art  ought  not  to  be  employed 
for  generic  names. 

61.  "  Names  of  classes  and  orders  are  to  be 
governed  by  the  same  rules  as  those  of  genera. 
The  name  is  to  be  single  ;  not  unmeaning,  hybrid, 
barbarous,  equivocal,  inapposite,  personal,  too 
long,  nor  harsh. 

62.  '•  Names  of  classes  and  orders  should  in- 
clude their  characteristic  marks. 

Of  specific  differences. 

> 

63.  "  A  perfect  name  includes  a  generic  and  a 
specific  name.  All  solid  learning  in  natural  his- 
tory, agriculture,  and  medicine,  depends  on  the 
knowledge  of  species. 

64.  "A  legitimate  specific  name  or  character 
distinguishes  the  species  from  all  others  of  the 


AND   YOUNG.  I95 

same  genus.     Trivial  names,  often  called  specific 
names,  are  subjected  to  no  very  accurate  rules. 

65.  "  All  specific  characters  which  distinguish 
the  species  from  others,  not  of  the  same  genus, 
arc  superfluous  and  bad. 

66.  **  Trivial  names  are  only  limited  to  a  single 
word.  (Substantives  have  an  advantage  over  ad. 
jectives,  as  being  more  convenient  when  brevity 
is  required ) 

6y.  "  Specific  characters  must  be  taken  from 
circumstances  not  subject  to  vary. 

68.  "  Magnitude  affords  no  specific  distinction. 
(Thus  the  degree  of  putrescency  scarcely  affords 
a  sufficient  distinction  between  nervous  and  pu- 
trid fever.) 

69.  "  Comparisons  with  other  genera  are  to  be 
excluded  from  specific  characters. 

70.  "  Comparisons  with  other  species  of  the 
same  genus  are  bad. 

71.  *'  Care  must  be  taken  to  exclude  varieties 
from  the  rank  of  species. 

72.  *'  Each  species  must  bear  the  name  of  the 
genus. 

73.  "  The  specific  name  must  always  follow  the 
generic.  The  idea  of  the  genus  must  occur  first 
to  the  mind. 


196  APHORISMS   OF   LINNAEUS 

74.  "  A  specific  name  without  the  generic  is 
like  a  bell  without  a  clapper. 

75.  "  The  specific  name  must  not  be  united  to 
the  generic  as  a  termination. 

"jd.  "A  genuine  specific  character  is  either 
synoptic  or  essential. 

jj.  "  A  synoptic  specific  character  distinguishes 
the  species  of  the  genus  by  successive  subdivi- 
sions into  two  portions.  In  large  genera  such 
subdivisions  are  often  indispensable. 

78.  "  An  essential  specific  character  exhibits  a 
single  distinction,  appropriate  to  one  species 
only. 

79.  ''  The  shorter  a  specific  character  can  be 
made,  the  better,  provided  that  it  be  sufficient. 

80.  *'  Specific  characters  must  contain  only 
such  words  as  are  necessary  for  distinguishing 
the  species  from  others  of  the  same  genus. 

81.  ''  When  a  genus  contains  only  one  species, 
a  specific  character  is  superfluous.  (There  may 
however  be  cases  in  which  a  character,  pointed 
out  as  likely  to  be  essential,  by  a  person  well 
acquainted  with  the  species,  may  be  useful  in  dis- 
tinguishing it  from  others  subsequently  dis- 
covered.) 

82.  *'  When  a   new  species  of  a  genus  is  dis- 


AND    YOUNG.  IQ/ 

covered,  the  characters  of  all  the  other  species 
must  be  accommodated  to  it,  if  they  become  in- 
adequate. 

83.  "  The  words  forming-  a  specific  character 
are  not  to  be  compounds  resembling  generic 
names,  nor  purely  Greek,  but  Latin ;  and  the 
more  simple  they  are,  the  better. 

84.  **  The  specific  character  ought  not  to  be 
embellished  by  the  flowers  of  rhetoric,  but  natu- 
ral and  faithful. 

85.  *'  The  specific  character  admits  neither 
comparatives  nor  superlatives. 

86.  "  The  specific  character  must  be  expressed 
in  positive  terms,  not  negative.  (Privatives  are 
often  unavoidable,  although  in  some  measure 
objectionable ) 

87.  '*  Resemblances,  if  ever  employed  for  spe- 
cific characters,  must  be  striking  and  well  known. 

88.  '*  Adjectives  mrast  immediately  follow  their 
substantives. 

89.  *'  Conjunctive  particles  are  to  be  excluded 
from  specific  characters,  except  v/here  they  are 
necessary  to  the  sense. 

90.  "  Successive  adjectives  are  not  to  be  sep- 
arated by  commas. 

91.  "  A  specific  character  must  never  contain 


198  APHORISMS   OF   LINNAEUS 

a  parenthesis,  whether  distinguished  or  not  by 
the  appropriate  mark.  A  parenthesis  is  bad,  as 
implying  a  defect  of  order. 

Of  varieties. 

92.  **  To  the  generic  name  and  specific  charac- 
ter the  distinction  of  a  variety  may  be  added, 
where  it  exists. 

93.  *'  The  generic  names,  the  specific  character, 
and  the  marks  of  varieties,  are  to  be  printed  in 
different  types. 

94.  ''  Very  slight  varieties  are  to  be  disre- 
garded. 

95.  ''The  specific  character  must  agree  with 
all  the  varieties,  as  far  as  is  practicable. 

96.  "  It  is  often  as  difficult  and  as  important  to 
reduce  varieties  to  their  proper  species,  as 
species  to  their  proper  genus. 

Of  Synonyms, 

97.  "  Among  the  synonyms  enumerated,  the 
most  approved  name  is  to  be  set  down  first. 

98.  "Authors  who  have  employed  the  same 
synonyms  are  to  be  quoted  together. 

99.  "  Each  synonym  is  to  begin  a  new  line. 


AND   YOUNG.  I99 

100  **  Synonyms  must  be  accompanied  by 
the  names  of  the  authors,  and  the  pages  of  the 
works  in  which  they  are  to  be  found." 

The  student  of  nosography  may,  with  profit, 
consult  the  modern  system  of  "  Laws  of  Botanical 
Nomenclature''  which  was  adopted  by  the  Inter- 
national Botanical  Congress  held  at  Paris  in 
August,  1867,  and  which  was  published  together 
with  a  historical  introduction  and  a  commentary 
by  Alphonse  De  Candolle. 


200  BIBLIOGRAPHY. 


SECTION  III. 

NOSOGRAPHICAL   BIBLIOGRAPHY. 

A  chronological  list  of  the  works  on  nosography  that  have 
appeared  from  the  time  of  Felix  Platerus  to  the  present. 

Platerus,  (Felix) — Praxeos  Medicae,  etc.  Bas- 
iliae,  1602. 

Warenius,  (Henricus) — Nosologia.  Leipsiae, 
1605. 

Petraeus,  (Henricus) — Nosologia  Harmonica, 
Dogmatica,  et  Hermetica.  Mar- 
burgi,  1614. 

Junius,  (Adrianus) — Nomenclator.  Francofurti, 
1620. 

JOHNSTONUS,  (J.) — Idea  Universalis  Medicinae. 
Amsteldami,  1644. 

SCHOENFELD,     (Phillipus     Jacobus) — Nosologia. 
Ingolstadii,  1675. 

Sauvages,  (Frangois  Boissier  de) — Nouvelles 
classes  des  Maladies  Dispos^es  dans 
un  Ordre  Semblable  a  celui  des 
Botanistes,  Comprenant  les  Genres 
et  les  especes.     Montpellier,  1732. 


BIBLIOGRAPHY.  201 

Sauvages,  (F.  B.  de)— Nosologia  Methodica. 
Lugduni,  1760,     Geneva,  1763. 

Hebenstreit,  (Johannes  Ernestus) — Program- 
mata,  Ordo  Morborum  Causalis. 
Leipsiae,  1754— 1757. 

Hebenstreit,  (J.  E.) — Exegesis  nominum  grae- 
corum,  quae  morbos  definiunt.  Lip- 
siae,  175 1 — 1761. 

Linnaeus,  (Carolus) — Genera  morborum.  Up- 
salae,  1759 — 1763. 

VoGEL,  (Rudolphus  Augustus) — Dissertatio,  Def- 
initiones  Generum  Morborum.  Goet- 
ingae,  1764. 

Plenk,  (J.  J.) — Novum  Systema  Tumorum  qui 
hi  morbi  in  sua  genera  et  species 
rediguntur.     Vienna,  1767. 

Cullenus,  (Guiliemus) — Synopsis  Nosologiae 
Methodicae  in  Usum  Studiosorum. 
Edin.,  1769, — 1772, — 1780. 

Cullen,  (William) — A  synopsis  of  Methodical 
Nosology,  etc.,  translated,  from  the 
fourth  edition,  by  Henry  Wilkins, 
M.  D.     Philadelphia,  1793. 

Cullen,  (W.) — Nosology,  etc.,  translated  from 
the  Latin.     Edin.,  1800. 


202  BIBLIOGRAPHY. 

CuLLENUS,  (G.) — Synopsis  nosologiae  melh- 
odicae,  etc.,  editio  sexta,  1803. 

CULLEN,  (W.) — The  works  of,  edited  by  John 
Thomson,  M.  D.,  etc.     Edin.,  1827. 

Sagar,  (J.  B.  M.) — Systema  morborum  symp- 
tomaticorum  secundum  classes,  or- 
dines,  et  genera,  cum  characteribus. 
Vienna,  1771.     Editio  tertia,  1783. 

Macbride,  (David) — A  Methodical  Introduction 
to  the  Theory  and  Practice  of 
Physic.     London,  1772. 

Selle,  (Christ.  T.) — Rudimenta  Pyretologiae 
Methodicae.     Berlin,  1773. 

Ackermann,  (J.  F.) — Programma  sistens  nosolo- 
giam  Holsaticam.     Kiloniae,  1773. 

Hartung,  (  ) — Diss,      de     generali      mor- 

borum divisione.     Aug.  Trev.,  1777. 

Hennemann,  (Guil.  Josephus) — Primae  lineae 
nosologiae  animalium.     Goettingae, 

1778, 

VlTET,  (Louis) — Medecine  expectante.  Lyons, 
1778.  (Containing  a  nosological 
method.) 

Haartmann,  (J.  J.) — Diss.  Sciagraphiae  mor- 
borum.    Aboae,^i779. 


BIBLIOGRAPHY.  203 

CiRlLLio,    (D.) — Nosologiae    Methodicae    Rudi- 

menta.     Napoles,  1780. 
TODE,  (J.  C.)  Copenhagen,  1781. 

Daniel,   (Chris.    Fredericus) — Sjstema  aegritu- 

dinum.     Leipsiae,  1781. 
GlESEKE,  (  ) — Animadversiones  in  systema 

nosologicum.     Goettingae,  1781. 

Vachier,     (  ) — **  Methode    nosologique.** 

Paris,  1785. 

Wallis,  (George) — Nosologia  methodica  ocu- 
lorum  ;  or  a  treatise  on  diseases  of 
the  eyes ;  selected  and  translated 
from  the  Latin  of  Francis  Boissier 
de  Sauvages,  with  annotations. 
London,  1785. 

Van    Heuvell,    (  ) — Tentamen    nosolog- 

icum, sistens  morborum  a  vitio  vis 
vitalis  divisionem  et  dispositionem 
practicam.     Lugduni  Batav.,   1787. 

Sprengel,  (Curtius) — Rudimentorum  nosologiae 
dynamicorum  prolegomena.  Hallae, 
1787. 

Baldinger,  (E.g.) — Opuscula  Medica,  containing 
among  other  dissertations,  animad- 
versionum  in  systema  nosologiae, 
specimina  1  et  IL  Goettingae,  1787-8. 


204  BIBLIOGRAPHY. 

LaUTH,    (Thomas) — Nosologia    chirurgica.     Ar- 

gentorati,  1788. 
Ploucquet,  (Guil.  Godofredus) — Delineatio  sys- 

tematis  nosologici  naturae  accomo- 

dati.     Tiibingae,  1791. 
Ploucquet,  (G.  G.) — Onomatopoeae  nosologiae 

fundamenta.     Tubingae,  1793. 
Dyrsen,  (  ) — Diss,  primae  lineae  systematis 

morborum  aetiologici.     Goettingae, 

1792. 

Arnemann,      (Justus) — Synopsis        Nosologiae. 
Goettingae,  1793. 

ASSUR,  (  ) — Diss.  Animadversiones  ad  sys- 

tema  nosologica  usitatiora.     Regio- 
montis,  1794. 

Darwin,  (Erasmus) — Zoonomia.  London,  1794 — 
1795. 

Grunner,  (Chris.  Gottfr.) — Nosologia  Historica. 
lenae,  1795. 

MUNCK,  (  ) — Diss,   sistens    nonnulas    circa 

nosologiam     methodicam     observa- 
tiones.     Lundini,  1796. 

Caillau,  (Jean  Marie) — Premieres  lignes  de 
nosologic  enfantine.  Bordeaux,  1797. 

PiNEL,  (Philip) — Nosoi^raphie  philosophique. 
Paris,  1798 — 1818. 


BIBLIOGRAPHY.  20$ 

Castel,  (Louis) — Analyse  critique  et  impartiale 
de  la  nosographie  philosophique  de 
Pinel.     Paris,  An  VII. 

Hoffmann,  (Philip) — Grundriss  eines  systems 
der  Nosologie  und  Therapie.  Elber- 
feld,  1798. 

Callisen,  (H.) — Systema  Chirurgiae  Hodiernae. 
Containing  a  classification  of  sur- 
gical diseases.     Copenhagen,  1798. 

Nebel,  (E.  L.  W.) — Specimen  nosologiae  bru- 
torum  cum  hominum  morbis  com- 
paratae.     Giessae,  1798. 

Villars,  (de  Grenoble) — Tableau  nosographique 
servant  d'introduction  a  la  con- 
naissance  des  maladies  internes  et 
externes,  1798. 

WiLLAN,  (Robert) — Description  and  Treatment 
of  cutaneous  diseases.  London, 
1798 — 1807. 

Brera,  (Valeriano  Luigi) — Classificazione  delle 
malatie  secondo  i  principi  di  Brown, 
si  premette  una  definizione  dei  vo- 
caboli  propri  del  sistema  Brovvniano. 
Venet.,  1799. 

Horn,  (Ernst) — Versuch  einer  praktischen  noso- 
logie der  fieber.     Brunsvic,  1800. 


206 


BIBLIOGRAPHY. 


Baumes,  (J.  B.  Th.) — Fondemens  de  la  science 
methodique  des  maladies.  Mont- 
pellier,  1801. 

Baumes,  (J.  B.  Th.) — Essai  d'un  syst^me 
chimique  de  la  science  de  Thomme. 
Nismes.  an  VI. 

Meyer,  (  ) — Diss,  integram  et  systematicam 

morborum  divisionem  dari  non 
posse  una  cum  nonnullis  observa- 
tionibus  de  principio  nosologiae 
Reschlaubianae  subjecto.  Franco- 
furti  ad  Viadrum,  1801. 

Tourdes,  (J.) — Esquisse  d'un  syst^me  de  noso- 
logic, fonde  sur  la  physiologic  et  la 
therapeutique.     Strasbourg,  1802. 

Bayle,  (G.  L.) — Considerations  sur  la  nosologic, 
la  medecine  d'observation,  et  la 
medecine  pratique,  suivies  d'observa- 
tions  pour  servir  a  I'histoire  des 
pustules  gangreneuses.     Paris,  1802. 

Abernethy,  (John) — Sui'gical  observations,  con- 
taining a  classification  of  tumors, 
etc.     London,  1804. 


BIBLIOGRAPHY.  20/ 

Abernethy,  (J.) — "  An  attempt  to  form  a  classi- 
fication of  tumors  according  to  their 
anatomical  structure."  In  the  Sur- 
gical works  of  John  Abernethy, 
F.  R.  S.  From  the  sixth  London  edi- 
tion.    Hartford,  Connecticut,  1825. 

Crichton,  (Alex.) — A  synoptical  table  of  dis- 
eases, exhibiting  their  arrangement 
in  classes,  orders,  genera,  and  spe- 
cies.    London,  1804. 

ToURTELLE,  (E.) — Elemens  de  medecine  theorique 
et  pratique.     1805. 

Salva,  (D.  F.) — Discorso  sobre  la  necesidad  de 
reformar  los  nombres  de  los  morbos, 
y  plan  para  hacerlo.  Barcelona,  1807. 

Parr,  (Bartholomew) — The  London  Medical 
Dictionary.   1809.    Article  nosology. 

SWEDIAUR,  F.  (18 1 2.) — In  Hosack's  system  of 
Nosology. 

Young,  (Thom^as) — An  introduction  to  medical 
literature,  including  a  system  of 
practical  nosology.     London,  18 13. 

Davidge,  (J.  B.) — Nosologia  methodica:  classium 
et  generum,  et  specierum,  et  varieta- 
tum  series  morborum  exhibens. 
Edit.  2d.     Baltimore,  181 3. 


208  BIBLIOGRAPHY. 

RiCHERAND,  (Anthelme)— Nosographie  chirur- 
gicale  4ieme  edition,  1815.  5ieme 
eHition,  1821. 

Herritz,  (Aloysius  Benedictus) — Diss,  sistens 
notiones  quasdam  de  summis  mor- 
borum  generibus.     Viennae,  181 5. 

DURET,  (J.  J.)— Tableau  d'une  classification 
generale  des  maladies.     Paris,    181 5. 

Good,  (John  Mason) — A  physiological  system  of 
nosology,  with  a  corrected  and  sim- 
plified nomenclature.    London,  1817. 

Good,  (J.  M.) — The  study  of  medicine.  London, 
1822. 

Bateman,  (Thomas) — Delineations  of  cutaneous 
diseases,  etc.     London,  1817. 

Seigneur-Gens. — Nosographie  Generale.  18 18. 

Alibert,  (Le  Baron  J.  L.) — Nosologic  naturelle, 
ou  les  maladies  du  corps  humain  dis- 
tribuees  par  families.  Paris,  1818 — 
1838. 

Hosack,  (David) — A  system  of  practical  nosol- 
ogy, etc.     New  York,  18 18 — 1821. 

PiNEL  ET  Bricheteau.  Article  nosographie 
dans  le  Dictionaire  des  Sciences 
Medicales.  Tome  36.     Paris,  18 19. 


BIBLIOGRAPHY.  209 

Barbier,  (J.  B.  Q.) — Precis  de  nosologic  et  de 
therapeutique  (unfinished).  Paris, 
1827. 

BoiSSEAU,  (F.  G.) — Nosologic  organique,  ou 
traite  complct  de  medecinc  pratique. 
4  vol.  8  vo.     Paris,  1828. 

Struve,  (L.  a.) — Synopsis  morborum  cuta- 
neorum  secundum  classes,  genera, 
species  et  varietates.     Berlin,  1829. 

PlORRY,  (P.  A.) — Traite  de  Medecinc  Pratique 
et  de  Pathologic  iatrique  on  medi- 
cale :  Polygraphies  ou  generalites. 
Vol.  I,  1841. 

Delorme,  (Raige) — Article  pathologic  in  the 
Dictionnaire  de  Medecine,  second 
edition,  vol  23.     Paris,  1841. 

BOUILLAUD,  (J.  B.) — Traite  de  Nosographie  med- 
icalc.     Paris,  1846. 

AlTKEN,  (William) — Science  and  practice  of 
medicine.  Article  nosology — con- 
taining Doctor  William  Farr's  classi- 
fication. 

The  nomenclature  of  diseases  drawn  up  by  a 
joint  committee  of  the  Royal  College  of  Physi- 
cians of  London.     London,  1 869. 

A  nomenclature  of  diseases  with  the  reports  of 


2IO  BIBLIOGRAPHY. 

the  majority  and  of  the  minority  of  the  commit- 
tee thereon.  Presented  to  the  American  Medical 
Association  at  the  meeting  held  in  Philadelphia^ 
May,  1872.     Philadelphia,  1872. 

Nomenclature  of  diseases  prepared  for  the  use 
of  the  medical  officers  of  the  United  States 
Marine  Hospital  Service,  by  the  Supervising- 
Surgeon,  John  M.  Woodworth,  M.  D.,  being  the 
classification  and  English-Latin  terminology  of 
the  provisional  nomenclature  of  the  Royal  Col- 
lege of  Physicians,  London.     Washington,  1874. 

Nomenclature  of  diseases.  State  Board  of 
Health  of  New  York  (No.  65).     New  York,  1883. 

Paul,  (F.  T.) — A  classification  of  the  new. 
growths  of  the  urinary  system  (Blad- 
der, Prostate,  and  Kidney).  British 
Medical  Journal,  January  12th,  1884^ 

Bronson,  (E.  B.) — The  objects  of  dermatological 
classification,  with  especial  reference 
to  Auspitz'  system.  Pamphlet,  pp. 
Reprinted  from  the  Journal  of  Cu- 
taneous and  Venereal  Diseases.  VoL 
II,  June,  1884. 

The  nomenclature  of  diseases  drawn  up  by  a 
joint  committee  appointed  by  the  Royal  College 
of  Physicians  of  London.  Second  edition,  being 
the  first  revision.     London,  1885. 


BIBLIOGRAPHY.  211 

Rabagliati,  (A.) — Some  remarks  on  the  classifi- 
cation and  nomenclature  of  diseases. 
(Reprinted  from  the  Medical  Press 
and  Circular).     London,  1886. 

Smith,  (Joseph  R.,  U.  S.  Army)— On  the  best 
form  of  report  of  the  sick  and 
wounded  of  Armies.  A  paper  read 
before  the  Section  on  Military  and 
Naval  Surgery  and  Medicine  of  the 
Ninth  International  Medical  Con- 
gress.    September,  1887. 

BroNSON,  (E.  B.) — A  study  of  the  considerations 
relating  to  the  classification  of  skin 
diseases  with  an  attempt  to  con- 
struct a  logical  system  in  accordance 
with  fundamental  principles  of  etiol- 
ogy. Pamphlet,  pp.  19.  Reprinted 
from  the  Journal  of  Cutaneous  and 
Genito-urinar}^  diseases.  October, 
1887. 


212 


SECTION  IV. 

BASIS   AND    METHOD    OF  THE   CLASSIFICATION 

AND  CHARACTER  OF  THE  NOMENCLATURE 

OF   THE    DISEASES   OF   MAN. 

Many  high  authorites  opposed  to  classification.  To  think  is 
to  classify.  Characteristics  of  good  classifiers.  Modern 
classifiers  use  terms  of  classification  arbitrarily  without  taking 
the  pains  to  define  these  terms.  Nosography  on  the  basis  of 
symptoms  misleading  and  retrogressive.  Anatomy  the  only 
stable  basis  for  nosography.  Description  and  definition  of  dis- 
eases. Methods  of  the  nosographer.  The  use  of  the  dead 
languages  in  nomenclature.  The  names  of  men  should  not  be 
applied  to  diseases.  Suggestions  for  an  improved  classifica- 
tion of  diseases.  A  consense  of  views  necessary  in  the  use  of 
terms  of  classification.  Questions  suggested  for  discussion 
at  the  Tenth  International  Medical  Congress.  Definitions  of 
the  terms  of  classification. 

As  preliminary  to  the  further  consideration  of 
human  nosography,  the  following  questions  may 
with  propriety  be  propounded  : 

1.  Is  there  need  of  classification  of  any  kind  ? 

2.  If  so,  what  should  be  the  basis  of  the  classi- 
fication of  diseases  ? 

3.  What  should  be  the  character  of  the  nomen- 
clature of  diseases  ? 

4.  What  should  be  the  method  of  the  classifica- 
tion of  diseases  ? 


NEED    OF   CLASSIFICATION.  21 3 

An  answer  to  each  of  these  questions  will  now 
be  submitted  to  the  decision  of  the  medical  pro- 
fession, for  no  official  nosography  should  be 
established  except  with  the  concurrence  of  the 
medical  profession. 

I.    IS   THERE   NEED    OF   CLASSIFICATION   OF 

ANY   KIND? 

Despite  the  well  known  aphorism,  "  system  is 
the  Ariadnean  thread  without  which  all  is  confu- 
sion," some  of  the  highest  authorities  in  science 
have  been  opposed  to  methodical  arrangement. 
Among  them  may  be  cited  the  celebrated  Buffon. 
Many  of  the  physicians  of  the  present  time  do 
not  approve  of  classification  notwithstanding  the 
fact  that  medicine  is  a  science  only  by  reason  of 
the  methodical  arrangement  of  diseases,  and  that 
these  physicians  themselves  are  constantly  classi- 
fying, for  they  think  and  therefore  classify,  and  it 
is  a  fact  that  to  think  is  to  classify,  therefore  in 
thinking  they  classify  nolens  volensj^     To  think  of 


*  "  Looking to  the  experience  of  the  past,  it  cannot, 

with  any  reason,  be  urged  that  systematic  arrangements,  if 
consistent  with  existing  knowledge  ever  cramp  or  hamper  a 
man  in  carrying  out  scientific  investigations  ;  on  the  contrary, 
they  enable  him  to  sec  more  clearly  in  what  direction  his  la- 
bor must  be  advanced,  and  demonstrate  more  forcibly  than 
otherwise  the  deficiencies  of  his  knov/lege."     (Aitken.) 


214  BASIS   OF   CLASSIFICATION. 

an  object  is  to  recognise  the  properties  which  dif- 
ferentiate it  from  other  objects  and  consequently 
place  it  in  its  proper  class. — Particular  illustra- 
tions need  not  be  given. — But  to  make  a  general 
classification  accurate  and  useful  requires  pro- 
found thinking,  a  good  understanding,  sound 
judgment,  persevering  study,  careful  observa- 
tion, persistent  labor,  untiring  industry,  and  the 
co-operation  of  many  men  possessing  these  quali- 
ties. Nosotaxy  however  to  be  of  practical  utility 
to  the  medical  profession,  and  of  much  benefit  to 
mankind,  requires  more  than  the  co-operation  of 
many  men.  It  exacts  the  prompt  and  substantial 
aid  of  the  very  great  majority  of  all  true  physi- 
cians in  the  world. 

The  answer  to  the  first  question  is  that  there  is 
great  need  of  a  classification  of  the  diseases  of 
man,  established  upon  a  proper  basis,  which  shall 
constitute  an  epitome  of  the  science  of  medicine. 

2.    WHAT   SHOULD   BE   THE   BASIS   OF   THE 
CLASSIFICATION   OF   DISEASES? 

During  this  century  nosography  has  not  ad- 
vanced so  rapidly  as  might  have  been  reasonably 
expected.  Among  the  chief  reasons  of  this  hin- 
derance  are ;  (i,)  that  the  establishment  of  a 
proper  basis  for  its  development  has  never  been 


BASIS   OF   CLASSIFICATION.  21$ 

agreed  upon  by  the  medical  profession,  and  (2,) 
that  no  particular  system  of  classification  has  been 
officially  adopted  by  the  profession.  Individuals 
and  certain  nations  having-  each  some  special  sys- 
tem of  classification  and  nomenclature  of  diseases, 
with  no  apparent  aim  toward  uniformity.  In 
sundry  nosographical  arrangements  the  words 
groups,  sections,  classes,  orders,  families,  tribes, 
genera,  and  species,  are  so  loosely  and  carelessly 
employed  that  it  is  difficult  to  understand  the 
meaning  which  these  terms  are  intended  to  con- 
vey, used,  as  they  often  are,  in  violation  of  estab- 
lished principles  of  classification,  for  many  classi- 
fiers employ  them  arbitrarily  and  do  not  take  the 
pains  to  give  their  own  definitions  of  these  arbi- 
trary terms. 

The  starting  point  in  nearly  all  the  systems  of 
nosography  is  the  symptom.  This  has  led  astray 
many  nosographers  who,  mistaking  symptoms  for 
diseases,  placed  these  symptoms  in  the  category 
of  diseases,  notwithstanding  the  existing  excellent 
rules  for  the  guidance  of  the  student  of  noso- 
graphy. The  system  of  Cullen  having  been 
judged  the  best  was,  for  many  years,  in  general 
use,  and  yet  it  was  full  of  the  most  glaring  errors, 
some  of  which  he  acknowledged  in  after  years. 
Many  of  Parr's  suggestions  were  excellent,  but 
his  system  was  as  ill  founded  as  those  of  his  pre- 


2l6  BASIS   OF  CLASSIFICATION. 

decessors.  Pinel's  "  nosographie  philosophique ^ 
which  superseded  the  nosology  of  Cullen  in 
France,  has  long-  been  obsolete.  It  failed,  even 
after  a  very  considerable  number  of  revisions, 
probably  because  it  was  established  upon  the 
same  faulty  basis  as  that  of  former  systems.  The 
nosographical  contributions  of  Recamier,  of 
Richerand  and  of  others  had  no  better  success. 
More  than  forty  years  ago  Doctor  Williams 
classified  and  tabulated  certain  diseases  upon  a 
physio-pathological  basis,  but  there  halted. 

It  seems  clear  that  the  great  defect  of  all  these 
systems  is  the  lack  of  a  stable  basis  upon  which 
to  erect  the  structure  of  nosography.  This  defect 
was  long  ago  realised  but  not  remedied,  and 
nosography  had  already  shown  signs  of  decay 
when  it  was  almost  entirely  reconstructed  by 
Doctor  William  Farr  and  by  the  Royal  College 
of  Pysicians  of  London.  But  even  the  modern 
English  system  is  full  of  inconsistencies  although 
it  is  declared  to  be  founded  upon  anatomy. 

It  is  noteworthy  that  nearly  all  the  early  gen- 
eral nosographers  were  at  either  extreme  of 
adopting  very  few  or  very  many  classes,  and  that 
they  failed  to  agree  as  to  what  should  constitute 
classes,  orders,  genera,  species,  or  symptoms,  for 
these  are  scattered  throughout  what  at  first  sight 
seem  to  be  the  most  methodical  arrangements. 


BASIS   OF   CLASSIFICATION.  21/ 

Thus  phlegmasiae  are  placed  among  classes  by 
Sauvages,  Linnaeus,  and  Sagar,  and  among  or- 
ders by  Cullen,  Vogel,  Macbride,  and  Good. 
These,  and  many  other  blemishes  already  pointed 
out,  occur  from  the  time  of  Sauvages  to  that  of 
Hosack,  and  are  owing  partly  to  the  fact  that  too 
little  attention  has  been  bestowed  upon  species 
notw^ithstanding  the  caution  of  Cullen  who,  how- 
ever, fell  into  the  error  he  so  much  wished  to 
avoid,  and  partly  to  the  state  of  knowledge  of 
physiology  and  morbid  anatomy  at  that  epoch. 
Although  Doctor  Good  based  his  nosology  upon 
physiology,  he  reaffirmed  many  of  the  errors  of 
the  older  authors. 

This  want  of  agreement,  and  the  absence  of  a 
substantial  foundation  and  of  associated  harmoni- 
ous labor,  have  given  rise  to  the  greatest  confu- 
sion in  the  use  of  terms  and  in  arrangement. 
This  confusion  and  the  tendency  of  each  noso- 
grapher  to  reproduce  the  inaccuracies  of  his  pre- 
decessors, have  greatly  impeded  the  progress  of 
nosography  and  have  led  to  much  unfavorable 
criticism  and  to  the  frequently  asked  question, 
*'  of  what  use  is  nosography  '*  ? — This  question  is 
now  often  sneeringly  asked  by  those  who  fail  to 
appreciate  the  fact  that,  without  the  existing  sys- 
tematic arrangement  of  diseases,  they  could  not 
have  learned,  and  could  not  intelligently  and  sue- 


2l8  BASIS   OF   CLASSIFICATION. 

cessfully  practise,  medicine. — In  the  beginning  of 
this  century  nosography  was  not  regarded  with 
much  favor  by  many  learned  physicians  both  in 
England  and  on  the  continent  of  Europe,  and  the 
mass  of  the  profession  spoke  of  it  contemptu- 
ously. Doctor  Parr,  in  commenting  thereon 
says :  ''  nosology  is  seldom  mentioned  but  to  be 
ridiculed  and  despised."  * 

Under  the  same  head,  Parr  says  : 

*'  Systems  are  the  work  of  our  own  minds ;  for 
nature  advances  by  almost  imperceptible  shades ; 
and  where  we  cannot  point  out  the  termination 
of  one  family,  and  the  commencement  of  another, 
it  is  only  confessing  that  the  intermediate  link  is 
unknown  :  thus  when  our  knowledge  advances 
the  advantages  of  our  system  lessen,  for  our  lim- 
its are  lost 

"  If  a  foundation  could  be  obtained,  it  was  ap- 
parently by  considering  the  disorder  as  connected 
with  an  internal  change,  which  would  then  afford 
what  might  be  styled  an  object,  whose  properties 
we  might  examine. .    

"  The  great  advantage  of  nosology  is  distinc- 
tion,   discrimination,    etc We  still 

want  a  delineatio  morbiiu  imitation  of  tht, delineatio 
plantae  in  Linnaeus." 


*  The  London  Medical  Dictionary.     London,  1809. 


BASIS   OF   CLASSIFICATION.  219 

How  can  proper  distinction,  discrimination, 
and  a  delineatio  morbi  be  made  unless  nosography 
have  a  stable  foundation  such,  for  instance,  as 
can  be  built  from  anatomy  ?  As  early  as  the 
year  1801  Bayle  was  of  opinion  that  nosography 
should  be  founded  upon  anatomy,  but  the  idea 
was  never  fully  carried  out,  although  Alibert 
named  his  families  of  diseases  in  accordance  with 
the  organs  affected,  although  Richerand  and 
others  made  similar  attempts,  and  although  the 
modern  English  system  is  avowedly  founded 
upon  anatomy."^ 

It  was  an  error  of  much  consequence  on  the 
part  of  the  nosographers  to  make  symptoms  the 
foundation  of  the  science  instead  of  using  them 
as  one  of  the  means  by  which  to  discover  individ- 
ual diseases.  An  anatomical  foundation  would  in 
no  way  have  lessened  the  importance  of  symp. 
tomatology  and  of  semeiology,  for,  however  sub- 
stantial might  have  been  the  foundation  of  noso- 
graphy, its  superstructure  could  never  have  been 
built  without  proper  methods  of  detecting  and  of 
expressing  the   characteristics   of  diseases.     It  is 


*  The  latest  work  of  Sauvages  (published  a  year  after  his 
death)  contained  a  symptomatica!,  an  etiological,  and  an 
anatomical  arrangement,  but  the  etiological  and  anatomical 
were  held  in  entire  subordination  to  the  symptomatical  ar- 
rangement. 


220  BASIS   OF   CLASSIFICATION. 

chiefly  by  the  aid  of  symptoms  and  signs  that  in- 
dividual affections  are  recognised  and  species 
established,  and  it  is  from  species  that  the  super- 
structure rises. 

While  due  consideration  should  be  given  to 
symptoms,  it  would,  in  the  present  state  of 
science,  seem  unwise  to  attempt  to  make  a 
delineatio  morbi  solely  upon  the  basis  of  symp- 
toms, for,  without  placing  under  contribution 
aetiology  and  pathoanatomy,  it  would  not  be 
possible  to  fix  a  term  for  every  circumstance  in 
which  the  morbid  conditions  might  vary.  For 
example,  in  the  case  of  a  deformity,  the  descrip- 
tion of  its  external  charaters  would  be  insufficient 
and  its  definition  inexact  if  the  cause  and  pathic 
properties  were  not  set  forth.  This  cause  may 
be  an  injury,  or  a  previous  disease,  or  the  de- 
formity may  be  congenital.  Again,  an  echmatic 
affection  may  be  owing  to  a  congenital  anomaly, 
to  a  previous  disease,  or  to  an  injury.  A  tumor 
may  consist  of  fat,  or  of  muscular  or  fibrous  tis- 
sue, of  cartilage,  or  of  bone,  or  of  cellular  ele- 
ments which  are  rapidly  proliferated  to  be  soon 
destroyed.  In  such  cases,  symptoms  would  in- 
dicate simply  the  existence  of  a  tumor  of  a  cer- 
tain size  and  shape  and  its  immediate  effects,  but 
not  its  anatomical  properties.  To  make  the  de- 
scription of  an  abnormal  condition  of  the  human 


BASIS   OF   CLASSIFICATION.  221 

body  accurate  and  its  definition  exact,  all  the  cir- 
cumstances connected  with  it  should  be  closely 
scrutinised  and  analyzed,  whether  they  be  ex- 
ternal manifestations,  or  physical  signs  brought 
to  light  by  the  aid  of  certain  tests  systematically 
applied,  as  for  instance,  in  the  case  of  the  sense 
of  hearing  in  auscultation,  of  touch  in  palpation, 
or  of  other  methods  of  physical  exploration.  At 
the  same  time  the  greatest  importance  should  be 
attached  to  the  causes  and  to  the  pathic  proper- 
ties of  these  conditions  as  revealed  by  the  mod- 
ern appliances  for  determining  the  anatomical 
and  other  characters  of  diseases,  such  as  chemical 
tests,  the  electrical  apparatus,  the  microscope, 
the  polariscope,  and  other  instruments  of  pre- 
cision. 

Cullen  speaks  of  the  difficulty  he  experienced 
in  determining  what  is  really  a  true  species  and 
what  is  onh'  a  variety,  and  finds  it  necessary  to 
enumerate  many  varieties.  Tliis  difficulty  doubt- 
lessly arose  from  his  adopting  a  system  based 
upon  symptoms  rather  than  upon  anatomy.  Some 
of  his  rules  for  discriminating  between  species 
and  varieties  would  now  be  of  little  value  and 
must  have  been  very  unsatisfactory  in  his  own 
time.  For  instance,  it  could  not  have  been  easy 
to  form  a  clear  conception  of  what  is  "  a  symp- 
tom   of   a   symptom,"  or  of    "a   symptom    of    a 


222  BASIS   OF   CLASSIFICATION. 

cause."  The  "  symptoms  of  symptoms "  have 
been  defined  as  "  effects  which  result  from 
the  symptoms  of  a  disease,  but  which  are  not 
necessarily  allied  to  the  disease,"  and  the  follow- 
ing example  is  given:  "thus  the  debility  which 
results  from  the  frequency  of  the  alvine  evacua- 
tions in  dysentery  is  a  symptom  of  symptoms." 
All  this  has  been  handed  down  from  the  time  of 
CuUen  and  seemingly  accepted  without  demur  or 
comment  on  the  part  of  the  profession  and  re- 
corded by  such  authors  as  Dunglison,  Littre  and 
Robin,  and  other  writers  of  eminence.  From 
symptoms  effects  cannot  arise,  for  symptoms  are 
only  manifestations  of  a  morbid  condition  which 
is  itself  the  effect  of  a  cause.  The  idea  of  an  ef- 
fect arising  from  a  manifestation  is  therefore  most 
irrational.  The  debility  which  results  from  such 
phenomena  as  the  frequent  alvine  evacuations  in 
dysentery  is  a  consequence  and  not  a  symptom 
of  the  dysentery.  The  outward  manifestations  of 
dysentery  are  the  frequent  bloody  alvine  evacua- 
tions accompanied  by  tenesmus.  The  analysis  of 
these  symptoms  furnishes  a  sign  upon  which  to 
base  the  diagnosis  of  the  disease. 

There  are  no  **  symptoms  of  a  cause "  any 
more  than  ;here  are  "  symptoms  of  symptoms." 
The   cause   produces   an   effect — disease — which 


BASIS   OF   CLASSIFICATION.  223 

effect  manifests  itself  by  certain  general  or  local 
symptoms. 

Of  late  years  it  has  been  proposed  to  employ 
two  classifications  and  nomenclatures,  one  for  the 
clinician,  based  upon  the  characters  of  the  symp- 
toms of  disease,  and  one  for  the  pathologist,  to 
be  used  in  the  autopsy  room.  Such  a  system 
would  be  entirely  unnecessary  if  a  single  classi- 
fication and  nomenclature  were  placed  upon  a 
proper  foundation. 

The  modern  botanical  classification  is  based 
upon  the  reproductive  organs  of  plants,  that  is, 
upon  anatomy. 

Zoological  classification  is  likewise  based  upon 
anatomical  characters,  and  this  basis  was  adopted 
to  a  certain  extent  by  Buffon,  notwithstanding 
his  general  opposition  to  methodical  arrange- 
ment, by  Pennant  in  his  history  of  quadrupeds, 
published  in  1781,  and  by  other  zoologists  of  their 
time. 

Looking  at  the  inorganic  world,  it  will  be  seen 
that  the  classification  of  minerals  is  based  upon 
their  chemical  properties.  The  system  adopted 
by  the  mineralogists  includes  classes,  orders, 
species  and  varieties. 

The  chemical  nomenclature  of  the  present,  the 
result  of  more  than  a  century  of  arduous  labor,  is 
based  upon  the   composition  of   compound  sub- 


224  BASIS   OF   CLASSIFICATION. 

stances,  so  that  the  name  of  a  chemical  compound 
generally  indicates  its  exact  composition. 

All  systematic  studies  of  those  sciences  wherein 
the  greatest  advances  have  been  made  during 
this  century,  are  established  each  upon  a  rational, 
a  substantial  basis,  except  medicine ;  and  w^hy 
the  good  example  set  by  the  naturalists  has  not 
been  more  generally  followed  by  medical  writers, 
it  is  not  easy  to  explain. 

A  nosography  based  upon  sysmptoms  cannot 
be  accurate  and  must  necessarily  fall. 

To  be  of  practical  utility,  the  classification  of 
diseases  should  be  based  upon  anatomy.  This  is 
the  answer  to  the  second  question. 

In  this  work  therefore,  an  attempt  is  made  to 
raise  the  superstructure  of  nosography  upon  this 
foundation. 

Dr.  Clymer,  whose  opinion  was  asked  in  rela. 
tion  to  the  question  of  the  basis  of  classification 
of  diseases,  writes  as  follows : 

"The  first  attempts  towards  a  classification  of 
diseases  are,  necessarily  along  the  lines  of  symp- 
toms. They  are  the  objective  marks  of  disorder ; 
the  salient  signs  that  compel  attention.  In  an 
early  state  of  study,  with  defective  knowledge  of 
substance  and  its  properties,  they  offer  the  one 
conception  of  departure  from  sound  working  we 
can  have.     True  scientific   research  is  bottomed 


BASIS   OF   CLASSIFICATION.  22$ 

on  observation.  The  unknown  cannot  be  made 
the  subject  of  positive  thought.  Cognition  is 
conditioned  on  experience,  which  comes  through 
perception ;  and  a  right  understanding  of  phe- 
nomena must  be  within  the  limitations  of  ex- 
periences, and  can  be  studied  successfully  only 
by  this  method. 

"  When  we  get  to  a  better  knowledge  of  sub- 
stance, its  forces,  and  their  variations,  the  artifice 
classification,  based  on  positive  data,  becomes 
possible.  It  will  be  more  or  less  perfect  in 
proportion  to  the  degree  and  fulness  of  such 
knowledge.  Berkeley  says  :  '  We  know  a  thing 
when  we  understand  it ;  and  we  understand  it, 
when  we  can  interpret,  or  tell  what  it  signifies.' 

"  When  the  square  of  the  hypotheneuse  is 
geometrically  demonstrated,  no  one  has  a  right 
to  his  own  notion  about  it. 

"  Facts  of  phenomena  arise  from  facts  of  sub- 
stance, otherwise  they  are  facts  of  fancy.  Symp- 
toms looked  at  alone  as  such  and  not  coupled 
with  the  suffering  substance  whose  speech  they 
are,  and  by  which  its  troubles  are  told,  will  mis- 
guide or  give  no  hint  of  the  true  state  of  things. 
Necessitated  correlation  of  matter  and  force  is  a 
primal  law.  No  change  in  the  customary  expres- 
sion of  an  activity,  whether  by  increase,  lessen- 
ing, arrest  or  perversion,  may  happen,   without, 


226  DESCRIPTION   AND   DEFINITION. 

at  like  time,  a  change,  coarse  or  fine,  in  the  plas- 
mode.  Hence,  as  a  matter  of  fact,  there  can  be 
no  such  thing-  as  mere  functional  disorder  apart 
from  structural  damage.  This  would  be  an  ab- 
straction, as  it  supposes  a  quality  without  sup- 
port, which  is  meaningless  and  contradictory. 
We  can  neither  know,  or  be  ignorant  of  an  ab- 
stract thing. 

*'  Facts  of  quantitative  or  qualitative  disturb- 
ance, made  known  by  objective  or  subjective 
tokens,  can,  therefore,  be  only  truly  expressed  in 
terms  of  substance." 

DESCRIPTION   AND   DEFINITION. 

Summarising  what  has  already  been  stated  as 
to  the  scope  of  nosography,  it  is  found  to  include: 
(i,)  the  description;  (2,)  the  definition;  (3,)  the 
nomenclature ;  and  (4,)  the  classification  of  dis- 
eases. 

The  description  of  a  disease  is  the  setting  forth, 
in  detail,  of  its  cause,  nature,  pathoanatomy, 
and  symptoms. 

The  definition  of  a  disease  is  the  statement  of 
its  peculiar,  dominant,  and  constant  characteris- 
tics so  concisely  and  clearly,  that  it  can  be  readily 
recognised. 

Description  and  definition  are  too  often  con- 


CHARACTER  OF  THE  NOMENCLATURE.   22/ 

founded.  An  exact  definition  is  the  summary  of 
an  accurate  description.  It  takes  from  such  de- 
scription only  what  is  essential  to  precisely 
characterize  a  disease  and  distinguish- it  from  any 
other  disease.  An  exact  definition  can  therefore 
be  deduced  from  the  analysis  only  of  a  complete 
description. 

In  the  description  of  a  disease  there  may  be 
symptoms  and  other  conditions  which  are  com- 
mon to  two  or  to  more  than  two  diseases.  To  in- 
troduce such  characters  into  a  definition  would 
vitiate  and  render  it  useless. 

The  methodical  nosographer  first  describes  a 
morbid  condition.  From  this  description  he  ex- 
tracts the  definition  and  from  the  definition  ob- 
tains the  correct  name  of  the  disease  which  he 
accordingly  classifies. 

3.    vVHAT   SHOULD   BE  THE   CHARACTER   OF 
THE  NOMENCLATURE   OF  DISEASES? 

Nosonomy,^  or  the  nomenclature  of  diseases  is 
that  division  of  nosography  about  which  there  is 


*  Nosonomy,  from  v66oi^  disease,  and  ovojuaf  name.  The 
words  know  and  name  are  said  to  be  traceable  to  the  same 
root.  Diseases  to  be  properly  named  should  therefore  first  be 
well  known. 


228   CHARACTER  OF  THE  NOMENCLATURE. 

the  least  agreement  among  both  the  ancient  and 
modern  authors ;  consequently,  of   all   scientific 
nomenclatures,  that  of   medicine   is   confessedly 
the  most  defective.     Of  the  many  good  rules  pre- 
scribed for  naming  diseases,  few  have  been  ob- 
served, and  many  of  the  most  absurd  and  mean- 
ingless    terms,     anciently     adopted,      are     still 
obstinately  retained.     A  pernicious  habit  of  in- 
accuracy among  writers  has  been  the  outcome  of 
this  faulty  nomenclature  which  now  proves  to  be 
one  of  the  greatest  detriments  to  the  science  and 
art  of  medicine.     Although    repeatedly  pointed 
out,  no  concerted  international  action  has   been 
taken  for  the  remedy  of  this  evil.     The  nearest 
approach  to  reformation  is  indicated  by  the  work 
done,  in  the  past  thirty  years,  by  the  medical  pro- 
fession of  the  advanced  European  nations,  more 
particularly  of  England.    Most  of  the  labor,  how- 
ever, was  individual,   and  performed   by  the  late 
Doctor  William  Farr,  of  London,  who  is  entitled 
to  the  highest  praise  for  his  devotion  to  this  sec- 
tion of  nosography.     He   has  done  much  to  ad- 
vance  nomenclature,    but   there    remains   much 
more   of  the   same  kind    of  work  to  be  accom- 
plished. 

Sir  W.  Aitken,  who  has  also  given  great  atten- 
tion to  the  question  of  nomenclature,  summarises 
**  the    considerations  which  have  generally  reg- 


CHARACTER  OF  THE  NOMENCLATURE.   229 

ulated  the  naming  of  diseases  "  as  follows:  *'(i,) 
some    names    have    been    taken    from    the   part 
affected — e.  g.,  peripneumonia,   podagra,  opthal- 
mia,    dysentery ;     (2,)    the    most    characteristic 
symptoms  have  furnished  the  name — e.  g.,  ileus, 
tenesmus,  paralysis,  diarrhoea,   dyspnoea,   coma  ; 
(3,)  some  names  have  been  taken  from  these  two 
circumstances  combined — e.  g.,   cephalalgia,  otal- 
g-ia,  cardialgia,    odontalgia,   hysteralgia ;    (4,)  an 
alteration    of    tissue     upon    which     subsequent 
changes   depend  being  recognised   as  the  essen- 
tial element  of  the  disease,  it  is  named  accord- 
ingly— e.    g.,     pleuritis,    peritonitis ;     (5,)     such 
alteration  not  being  discovered,   the  first  tangi- 
ble   link    in    the   chain   of    causation    has   been 
used  instead — e.  g.,  m.elancholia,  cholera,  typhus ; 
(6,)    when  a  lesion    tending  to  sudden    death   at 
once  follows  the  application  of  a  cause,  that  cause 
may  name  the  disease — e.  g.,  lightning,   prussic 
acid,    arsenic,   scald,    sun-stroke,  cut,  stab,  frost- 
bite, etc. :  (7,)  a  considerable  number  of  names  of 
diseases  have  been  derived  from  some  imaginary 
resemblance  to  external  objects — e.  g.,  elephanti- 
asis, cancer,  polypus,  anthrax,  etc. ;  (8,)  there  are 
still    many  names  the    origin  of   vi^hich  it   is  not 
easy  to  trace." 

Faulty  as  are  these  and  many  other  terms,  it  is 
extremely  difficult  to  fill  their  places  with  suit- 


230       CHARACTER  OF  THE   NOMENCLATURE. 

able  expressions.  That  this  will  in  time  be  ac- 
complished— perhaps  however  not  until  two  or 
three  generations  of  physicians  shall  have  passed 
away — is  reasonably  to  be  anticipated.  Mean- 
while it  is  to  be  hoped  that  durmg  the  present 
generation  good  substitutes  will  be  offered  for 
such  caconymous  terms  as  podagra,  rheumatism, 
apoplexy,  melancholia,  ileus,  dysentery,  diar- 
rhoea, cholera,  typhus  and  typhoid  fevers, 
variola,  diphtheria,  hydrophobia,  elephantiasis, 
lupus,  leprosy,  anthrax,  cancer,  chancre,  chan- 
croid, scrofula,  syphilis,  and  a  host  of  other 
equally  inappropriate  names  of  diseases. 

Many  of  these  terms  are  used  in  this  essay — 
but  under  protest — until,  by  general  agreement, 
correct  terms  shall  be  substituted. 

"  The  perfection  of  a  science  depends,  in  no 
inconsiderable  degree,  upon  the  perfection  of 
its  language ;  and  the  perfection  of  every  lan- 
guage upon  its  simplicity  and  precision."  * 

The  language  of  medicine  should  be  euphoni. 
ous,  simple,  expressive,  and  accurate,  for,  its  ob- 
ject is  not  only  to  describe  and  define  diseases 
with  precision,  but  to  mirror  the  medical  ex- 
perience, wisdom,  and  genius  of  the  past  as  well 
as  of  the  present.     Nosographical  nomenclature 


*  John  Mason  Good. 


CHARACTER  OF  THE  NOMENCLATURE.   23 1 

is  the  most  important  part  of  medical  language 
and  consists  of  the  technical  terms  therein  used. 
This  nomenclature  should  be  based  upon  the 
structural  characters,  of  the  affections  of  the  hu- 
man body  ;  therefore  the  names  given  to  diseases 
should  convey  to  the  mind  an  exact  idea  of  the 
morbid  conditions  which  these  names  are  de~ 
signed  to  express,  at  least  a  strong  endeavor 
should  be  made  toward  the  attainment  of  that 
end.*     As  a  general  rule  these  names  should  be 


*  "  The  exactness  of  names  and  the  uniformity  of  terms 
render  more  facile  and  prompt  the  knowledge  of  a  science, 
and  an  expressive  and  characteristic  denomination  makes  a 
profound  impression  upon  the  mind  which  necessarily  puts 
the  object  designated  into  the  place  of  its  designation."^ 
(Paraphrased  from  Condillac  by  Pinel.) 

Condilliac  in  commenting  upon  nomenclature  propounded 
the  following  aphorism.  "  Les  sciences  se  reduisent  d  des 
langues  Hen  faztes."  This  may  be  liberally  translated  into,, 
sciences  may  be  reduced  to  exact  language. 

"  It  is  the  exactness  and  also  the  good  use  of  words,  or 
more  generally  of  signs,  which  should  be  considered  as  the 
criterion  of  the  truth ;  it  is  to  their  vague  character,  to  the  un- 
certain and  confused  manner  in  which  they  are  employed,  that 
should  be  attributed  imperfect  notions,  prejudices,  errors,  and 
all  vicious  habits  of  the  mind. 

"  In  nearly  all  the  departments  of  medicine,  the  language  is 
ill  constructed.  It  has  been  more  and  more  corrupted  by  the 
false  application  of  words  borrowed  from  the  other  sciences^ 


232   CHARACTER  OF  THE  NOMENCLATURE. 

Latin  or  Latinised  Greek,  or  of  Greek  or  Latin 
derivation  but  should  not  be  compounded  of 
Latin  and  Greek.  To  avoid  confusion  it  is  de- 
sirable that  one  name  only  be  adopted  lor  each 
individual  disease.  When  a  disease  already  bears 
several  names,  if  one  of  these  be  accurate  it 
should  be  adopted  to  the  exclusion  of  the  super- 
fluous or  improper  names,  otherwise  a  correct 
term  should  be  coined,  and  the  other  names 
should  be  placed  under  the  head  of  equivalents, 
synonyms,  or  caconyms,  as  the  case  may  be. 

The  names  of  men  applied  to  diseases  are  ex- 
tremely objectionable,  convey  no  idea  of  the 
nature  of  these  diseases,  and  even  fail  to  flatter 
vanity.  It  happens  sometimes  that  a  disease 
bears  the  names  of  tv\ro  persons  whose  descrip- 
tion thereof  is  the  same.  May  it  not  also  happen 
that  one  and  the  same  disease  is  very  differently 
described  by  two  or  even  three  persons,  each  giv- 
ing his  name  to  the  disease,  so  that  two  or  three 
diseases  may  be  enumerated  where  only  one 
exists  ?  The  resulting  confusion  and  perplexity 
would,  in  such  a  case,  be  most  discouraging  to 
earnest  students.     The  fashion  of   giving  men's 

and  by  a  certain  insignificant  and  ridiculous  jargon  which  has 
too  often  been  adopted  by  physicians  owing  to  a  culpable  re- 
spect for  popular  prejudices."     (Cabanis.) 


CHARACTER   OF  THE  NOMENCLATURE.       233 

names  to  diseases  has  continued  through  so  long- 
a  series  of  years  that  it  has  grown  into  a  con- 
firmed and  mischievous  habit.  If  this  sentimental, 
but  mistaken,  notion  of  honoring  or  of  rewarding 
merit  could  have  been  limited,  no  great  harm 
would  have  ensued.  The  evil  is  however  already 
an  offensive  blot  upon  the  nomenclature  of  medi- 
cine, and  threatens  to  mar  the  best  pages  of 
medical  literature.  Will  it  not  be  a  most  agree- 
able relief  to  the  senses  of  the  heedful  reader 
when  authors  shall  have  banished  from  their 
treatises  such  terms  as  Addison's  disease,  Base- 
dow's disease,  Bright's  disease,  Charcot's  disease, 
Duchenne's  disease,  Dupuytren's  contraction, 
Graves'  disease,  Hodgkins'  disease,  Meniere's 
disease,  Pott's  disease,  and  very  many  more  of 
kindred  names  which  express  no  notion  of  the 
nature  of  the  affections  bearing  such  pseu- 
donyms ? 

The  names  of  regions  of  country — e.  g.,  Bar- 
badoes  leg  ;  of  animals — e.  g.,  lupus,  elephantia- 
sis ;  of  vegetables — e.g.,  hay  fever;  of  some  of 
the  elements — e.  g.,  St.  Anthony's  fire  ;  and 
other  names  too  absurd  and  too  numerous  to 
particularise  have  been  given  to  diseases. 

The  same  faulty  nomenclature  exists  in  the 
fundamental  science  and  associated  arts  of  medi- 
cine. 


234       CHARACTER   OF   THE   NOMENCLATURE. 

It  is  to  be  hoped  that  the  much  desired  general 
reformation  in  medical  nomenclature  will  soon 
begin,  but  the  bad  foundation  must  first  be 
sapped  by  a  radical  change  in  the  nomenclature 
of  the  fundamental  science  and  associated  arts  of 
medicine. 

The  answer  to  the  third  question  is  that  the 
nomenclature  of  diseases,  to  be  exact,  should  be 
based  upon  the  true  nature  of  morbid  conditions 
and  should  be  characterized  by  simplicity,  brev- 
ity and  accuracy. 

Inasmuch  as  many  of  the  words  employed  by 
the  earliest  nosographers  are  now  largely  used, 
and  inasmuch  as  their  use  will  probably  be  con. 
tinued  for  a  long  time,  it  is  proper  that  the  inten- 
tion of  their  coinage  be  clearly  understood. 
Doctor  John  Mason  Good's  nosology  contains  a 
full  explanation  of  many  of  the  terms  employed 
by  Sauvages  and  other  contemporaneous  nosog- 
raphers, and  also  a  table  of  some  of  the  medical 
prefixes  and  terminals  with  a  brief  statement  of 
the  senses  in  which  they  are  applied.  This  table 
of  prefixes  and  terminals  is  here  reproduced  for 
the  benefit  of  those  who  may  desire  to  know  their 
exact  meaning  as  understood  when  they  were 
coined. 


235 
good's  table  of  prefixes  and  terminals 
with  the  senses  in  which  they 

ARE    USED  * 

Prefixes. 

A,  («),  Diminution  or  less  quality  or  power. 

fFor   the   most   part 
A^^    „^ u    t  ^       ^       ^        iterative,  duplicate^ 

rff.'  ^?;f  ■  *     V  '    ^''^    or    augmented    ac: 

tion :  but  often  m^ 
determinate. 


Cata,  cat,  {>iaraj  nar). 


Dia,  (<5ta),  Separation  ;  secernment ;  or  secretion. 

Dys,  (5i»5),  Morbid  state  or  action  generally,  em- 
phatical,  when  accompanied  with  dis- 
tress or  difficulty. 

Ec,  ex,  (£«,  £^),  ]     r^  i.      f  4.        J 

Epi,  ep,  eph,  (£^z,  £^,  £^),  t     ^"t    «f;      outwards  r 
Hyper,  (^^£^),  f         «^^^*'  ^^ove. 

Hj^po,  {v7to),  Under. 

En,  (er),  Within  ;  below  ;  applied  to  places.  Su- 
periority ;  excess  or  intensity  ;  applied 
to  quantity  or  quality. 


*  A  more  extended  table  of  prefixes  and  terminals  is  to  be 
found  at  the  end  of  Volume  I,  of  Piorry's  "  Trate  de  Medi- 
cine Pratique  et  de  Pathologie  latrique  ou  Medicate,. 
Generalites."  1841. 


236  PREFIXES   AND   TERMINALS. 

Para,  {itapa),  Morbid  state  or  action  generally ; 
and  hence  synonymous  with  dys\ 
except  in  a  few  terms  derived  from 
anatomy,  in  which  it  imports  apud^ 
"  bordering  on,"  as  in  parotitis,  pa- 
ronychia. 

Peri,  {itepi),  Circuit;  circumference. 

Terminals. 

Algia,  {aXyia)^  Pain  or  ache. 

"]  Morbid  action,  pow- 
Asmus,  osmus,  {a6^a,  odjuoi)  |     er,     or    possession 
Esmus,  ismus,  (£(^mo?,  idjao^),    \-   generally  ;       but 
Esis,  osis,  {e6i?,  (iodi<^)j  mostly    very   inde- 

terminate. 

lasis,   {ladii)^    Cutaneous    eruption,    unconnected 

with  fever  as  its  cause. 
Itis,  {iri7^),  Organic  inflammation. 

Kele,  cele,  i^i'n'^v),    Covered    protrusion   of   a   soft 

part. 
Odes,  (ta^T^s),  Like  ;  akin  to. 
Oma,  (o^ywa),  External  protuberance. 
Ptoma,  {TtTGo^ia)^  Naked  prolapse  of  a  soft  part. 
Rhoea,  (/^oza),  Preternatural  flux  of  any  fluid  ex- 
cept blood. 
Rhagia,  {pocyia)^  Preternational  flux  of  blood. 


METHOD    OF   THE   CLASSIFICATION.  23/ 

Latin  terminals. 
Igo,  Diffuse  or  migratory  action  or  motion. 

rn  '  •      \     '     \  Simple  diminutive  terminations, 
lilaris,  ularis,  j  ^ 

Osus,  Simple  augmentive  termination. 

4.    WHAT   SHOULD   BE   THE   METHOD    OF   THE 
CLASSIFICATION   OF   DISEASES? 

Nosotaxy  or  the  classification  of  diseases. — The 
fourth  division  of  nosography  relates  to  the 
grouping  of  those  diseases  that  have  been  de- 
scribed, defined,  and  named,  and  to  their  arrange- 
ment into  distinct  classes,  orders,  genera,  and 
species.  This  is  called  taxonomy  *  or  classifica- 
tion. 

Next  to  nomenclature,  classification  has  exhib- 
ited the  most  diversified  and  incongruous  views. 
At  the  close  of  the  last,  and  in  the  beginning  of 
this  century,  classification  was  in  such  fashion 
that  ^M^rj  prominent  physician  thought  himself 
bound  to  construct  a  new  classfication  of  dis- 
eases. The  result  was  that  no  two  systems  agreed  ; 
and  that  nearly  all  classifiers  not  only  repeated  the 


*  Taxonomy,  from  ra'^z?,  arrangement,  and  v6/ioi,  a  law; 
and,  for  the  sake  precision  and  brevity,  nosotaxy,  the  classifi- 
cation of  diseases. 


^38  METHOD   OF  THE   CLASSIFICATION. 

heresies  of  their  predecessors,  but  often  made 
greater  mistakes,  so  that  nosograpby  soon  fell 
into  disrepute  and  contempt.  The  excessive 
^eal  displayed  b)''  many  of  these  classifiers  in  en- 
deavoring* to  promote  nosography,  and  their  pre- 
mature publication  of  imperfect  and  ill  digested 
systems,  are  among  the  main  causes  of  the  re. 
tardation  of  its  progress. 

Sir  W.  Aitken,  in  his  warm  advocacy  of  meth- 
ical  arrangement,  predicts  a  glorious  future  for 
nosography. 

He  says,  under  the  head  *'  principles  of  classi- 
fication "  : 

"  A  perfectly  philosophical  or  natural  system 
of  classification  aims  at  having  the  details  of  its 
plan  to  agree  in  every  respect  with  the  facts  as 
they  exist  in  nature,  and  to  be  as  it  were  a  *  trans- 
lation of  the  thoughts  of  the  Creator  into  the 
language  of  man.'  To  effect  this  end,  arrange- 
ments, as  they  naturally  exist,  require  to  be 
traced  out,  not  devised.  The  tracts  in  which  our 
knowledge  is  as  yet  deficient,  may  be  shortly  in- 
dicated under  the  following  heads:  (i,)  the 
affinities  or  alliances  of  diseases  with  each 
other  ;  (2,)  the  morbid  anatomy  of  diseased  parts? 
(3,)  the  communication,  propagation,  inoculation, 
generation,  development,  course,  and  spontaneous 
natural  termination  of  diseases  ;  (4,)  the  connec- 


METHOD    OF   THE   CLASSIFICATION.  239 

tion  of  the  phenomena  recognised  during  life 
with  the  facts  of  morbid  anatomy  ;  (5,)  the  geo- 
graphical distribution  of  diseases  ;  (6,)  the  suc- 
cession of  diseases,  so  far  as  they  can  be  traced 
through  past  ages ;  the  peculiarities  they  have 
exhibited  at  different  periods  in  the  world's  his- 
tory, or  within  comparatively  recent  cycles  of 
years.  "But,"  he  further  says,  "the  time  has 
not  yet  come  for  a  classification  on  a  basis  so 
comprehensive — simply  because  the  material 
does  not  yet  exist;  and  attempts  to  make  so- 
called  natural  systems  of  arrangement  must  end 
in  disappointment,  on  account  of  the  uncertain 
and  fluctuating  data  on  which  they  must  be 
based." 

It  is  true  that  the  whole  of  the  material  does 
not  yet,  and  may  never,  exist  for  "  a  perfectly 
philosophical  or  natural  system  of  classification," 
but  there  is  enough  good  material  at  hand, 
which,  if  wisely  used,  will  greatly  improve  the 
present  systems  of  classification.  It  surely  is  not 
the  part  of  wisdom  to  wait  an  indefinite  time  to 
begin  this  work.  Had  the  early  nosographers 
waited  for  the  "  proper  time  to  come,"  this 
science  would,  to-day,  scarcely  be  in  existence. 
But  they  quickly  made  use  of  such  material  as 
was  then  at  hand  and  their  labors  have  led  largely 
to  the  advances  which  are  at  present  enjoyed. 


240  METHOD    OF   THE   CLASSIFICATION. 

The  succeeding  generations  of  nosographers  wil 
doubtless  profit  by  the  good  work — and  by  the 
errors  too — of  the  preceding,  and  it  may  possibly 
be  many  centuries  before  the  fond  hope  of  Sir  W. 
Aitken  can  be  realised,  but  the  beginning  should 
be  made  now. 

The  task  of  improving  the  classification  of  dis- 
eases may  be  begun  by  individuals,  but  individual 
labor  should,  with  good  grace,  be  submitted  to 
the  criticism  and  correction  of  other  individuals 
and  of  organized  associations  of  the  medical  pro- 
fession, first  of  the  country  of  these  individuals, 
then  of  all  countries  of  the  world. 

The  study  of  the  nosography  of  the  past,  show- 
ing, as  it  does,  such  great  diversity  in  the  many 
systems,  such  lack  of  agreement  among  the  no- 
sographers, such  confusion  in  classification,  and 
such  eccentricity  in  nomenclature,  must  needs 
lead  to  the  conclusion  that  it  is  not  possible,  in 
the  existing  state  of  medical  science,  for  any  one 
person,  or  for  a  single  association,  or  even  for  the 
medical  profession  of  one  or  of  several  nations  to 
produce  a  complete  general  nosography.  The  un- 
successful efforts  already  made  in  this  direction 
for  the  past  century  and  a  half  are  good  evi- 
dences of  the  correctness  of  this  proposition. 
Many  individuals  may  each  prepare  the  nosog- 
raphy of  one  apparatus  of  the  human  body  and 


METHOD   OF  THE   CLASSIFICATION.  24I 

thus  doubtless  give  substantial  aid  in  the  cause  of 
nosography  and  contribute  thereto  much  valua- 
ble material ;  but,  in  view  of  the  progressive 
character  of  medical  science,  the  details  of  all 
such  work  must  necessarily  be  provisional  and 
constantly  subjected  to  alterations  and  revisions. 
The  final  decision  of  questions  relating  to  the 
general  principles  of  nosography,  and  tending  to 
make  the  nomenclature  of  medicine  uniform  in 
all  countries,  should  be  made  by  an  assembly  of 
representant  physicians  of  all  nations,  through  in- 
ternational conferences,  so  that  every  individual 
member  of  the  medical  profession  may  know  that 
his  voice  shall  be  heard  for  or  against  the  adop- 
tion of  any  proposed  method  of  nomenclature 
and  classification  of  the  diseases  of  man.  By  this 
means  only  can  a  comprehensive  system  of  no- 
sography be  compiled  which  will  be  of  practical 
utility  to  all  nations  for  the  purposes  of  vital 
statistics  and  of  the  medical  reports  of  armies, 
navies,  and  general  hospitals,  or  for  the  use  of 
students,  teachers  and  investigators. 

The  answer  to  the  fourth  question  is  that  the 
excellent  method  of  classification,  borrowed  from 
the  botanists,  by  the  early  medical  classifiers, 
should  be  re-adopted  with  the  modifications  in- 
dicated below. 

If  the  majority  of  the  medical  profession  of  the 


242  METHOD   OF   THE   CLASSIFICATION. 

world  should  decide  in  favor  of  classifying  the 
diseases  of  the  human  body,  as  heretofore,  like 
systems  of  botany,  it  would  seem  rational  to  base 
the  classification  upon  anatomy  in  its  broadest 
sense ;  and  such  a  basis  is  the  one  which  offers 
the  greatest  advantages  and  the  widest  scope  in 
theory  and  in  practice.  A  knowledge  of  the 
gross  appearances  and  of  the  construction  and  re- 
lations of  the  several  parts  of  the  body  ;  of  the 
minute  structure  of  the  tissues  and  organs ;  of 
the  development  and  abnormities  of  the  organs; 
of  the  functions  of  the  apparatuses ;  and  of  the 
nature  of  morbid  conditions,  is  of  the  utmost  im- 
portance. Nay  more,  a  mastery  of  these  various 
branches  of  anatomy  is  essential  to  the  study  of 
the  natural  history  of  diseases.  By  its  aid,  all  de- 
viations from  the  normal  state  of  the  body  or  any 
part  thereof  are  at  once  recognised.  It  remains 
only  to  differentiate  these  abnormal  conditions 
and  to  define,  name,  and  classify  them.  These,  it 
seems,  are  sufficient  grounds  for  the  adoption  of 
the  anatomical  basis  for  the  nosography  of  man. 
It  is  therefore  suggested  that  all  diseases,  in- 
juries, and  congenital  abnormities  be  grouped 
into  families,  one  family  for  each  apparatus  of 
the  body,  and  one  or  more  than  one  family  for 
general  diseases.  Some  of  the  families  should 
have  two  or  more  than  two  branches,  and  fami- 


METHOD   OF  THE   CLASSIFICATION.  243 

lies  and  their  branches  should  be  divided  into 
classes,  orders,  genera,  species,  sub-species,  varie- 
ties and  sub-varieties. 

It  is  of  the  utmost  importance  that,  in  the  med- 
ical profession,  there  be  a  consense  of  views  con- 
cerning not  only  nomenclature  and  methodical 
arrangement  but  also  the  use  of  the  terms  of 
classification.  Notwithstanding  the  fact  that  the 
early  nosographers  indicated,  as  best  suited  to 
the  purposes  of  nosography,  the  simple  arrange- 
ment of  diseases  into  classes,  orders,  genera, 
species,  and  varieties,  the  most  recent  of  the 
modern  medical  classifiers  begins  with  classes 
and  after  orders  introduces  "  sub-orders,  tribes, 
and  families,"  next  to  which  he  places  genera, 
species,  and  varieties.  Such  a  method  only  leads 
to  confusion,  complication,  and  uncertainty.  Sim- 
ilar methods  have  been  tried  in  medicine  and 
found  wanting  in  clearness  and  accuracy. 

The  plan  proposed  in  this  work  does  not  in- 
clude sub-orders,  or  tribes.  Families  are  applied 
to  the  groups  of  diseases  dwelling  in  the  appara- 
tuses of  the  body. 

The  nosographer  who  lays  before  the  profes. 
sion  a  system  of  classification  is  in  duty  bound  to 
give  an  exact  definition  of  each  and  every  term 
of  classification  which  he  employs,  in  order  that 
he  may  be  rightly  understood. 


244  QUESTIONS   FOR  THE  TENTH 

Only  those  terms  of  classification  that  are  ap- 
proved by  the  medical  profession  should  be  used 
in  a  special  or  in  a  general  nosography. 

The  sooner  the  question  of  method  is  put  to  a 
vote,  after  free  discussion  in  an  association  rep- 
resenting the  medical  profession  of  the  whole 
world,  the  better  it  will  be  for  the  cause  of  ac- 
curate nomenclature  and  classification. 

Therefore  the  following  questions  are  sug- 
gested for  discussion  at  the  Tenth  International 
Medical  Congress. 

1.  Shall  there  be  instituted  an  International 
system  of  nomenclature  and  classification  of  the 
diseases  of  man  ? 

2.  If  so,  what  shall  be  the  basis  of  this  nomen- 
clature and  classification  ? 

3.  What  shall  be  the  character  of  the  nomen- 
clature ? 

4.  What  shall  be  the  method  of  the  classifica- 
tion ? 

5.  What  shall  be  the  nature  of  the  terms  used 
in  the  classification  ? 

6.  Shall  these  terms  be  defined  ? 

In  case  the  first  question — shall  there  be  insti- 
tuted  an   international  system  of  nomenclature 


INTERNATIONAL   CONGRESS.  245 

and  classification  of  the  diseases  of  man? — be  de- 
cided in  the  affirmative,  it  is  further  suggested : 

1.  That  the  International  Medical  Congress  es- 
tablish a  permanent  section  on  the  nomenclature 
and  classification  of  the  diseases  of  man,  to  be 
composed  of  physicians  and  surgeons  represent- 
ing the  medical  profession  of  all  nations. 

2.  That  all  national  medical  associations  like- 
wise establish  each  a  section  on  the  nomenclature 
and  classification  of  diseases,  composed  of  physi- 
cians and  surgeons  representing  different  regions 
of  country,  in  order  that  their  knowledge  of  the 
peculiarities  presented  by  disease  in  differing 
climates  may  be  made  available  in  the  work  to  be 
accomplished. 

3.  That  state,  city,  and  special  medical  associa- 
tions, through  their  presiding  officers,  each  ap- 
point a  committee  on  the  nomenclature  and 
classification  of  diseases. — This  can  be  effected 
without,  in  any  way,  deranging  the  machinery  of 
these  associations. 

4.  That  the  city  and  special  associations  report 
to  the  State  Associations  such  action  as  they  may 
take  upon  the  proceedings  of  their  committees. 

5.  That  the  reports  of  the  city  and  special 
associations   be   embodied   in   the  report  of   the 


246  INTERNATIONAL  CONGRESS. 

State  committee,  and  the  consolidated  reports  be 
presented  to  the  State  Association  for  action  and 
transmission  to  the  national  association. 

6.  That  the  national  association  refer  the  state 
report  to  the  national  section  on  nomenclature, 
etc.,  for  a  report  after  careful  examination  and 
free  discussion.  The  report  to  be  acted  upon  by 
the  National  Association  and  forwarded,  or  pre- 
sented by  a  delegate,  to  the  section  on  nomen- 
clature and  classification  of  the  International 
Medical  Congress. 

7.  That  the  section  on  nomenclature  and  classi- 
fication of  the  International  Medical  Congress 
then  revise  the  several  national  reports,  consoli- 
date them,  and  present  their  conclusions  to  the 
Congress  whose  decision  thereon  should  be  final. 

These  suggestions  are  made  in  the  belief  that 
they  point  to  a  fair  method  of  obtaining  the  views 
and  the  vote  of  the  whole  medical  profession  on 
a  subject  of  the  vastest  importance  to  mankind, 
and  also  to  the  most  expeditious  way  to  attain 
the  desired  end  of  compiling  a  uniform  nomen- 
clature and  classification  of  diseases  that  may  be 
of  practical  utility  to  all  nations. 


247 

DEFINITIONS   OF  THE   TERMS   OF 
CLASSIFICATION. 

The  following  definitions  of  the  terms  of  classi- 
fication are  modeled  upon  botanical  nomencla- 
ture, except  those  of  family,  class,  and  order, 
which  do  not  here  occupy  the  same  relative  posi- 
tions as  in  works  on  Botany  and  Zoology. 

1.  Families  of  diseases.'*' — A  family  is  a  group  of 
diseases  dwelling  in  an  apparatus  of  the  human 
body  and  affectmg,  in  a  greater  or  less  degree, 
the  organs  of  this  apparatus  and  consequently  its 
function.  Therefore  affections  of  the  organs  of 
an  apparatus,  and  also  general  diseases  affecting 
several  apparatuses  at  once,  should  be  grouped 
into  families. 

2.  Branches  of  families. — A  branch  of  a  family 
of  diseases  is  a  division  of  the  family  predicated 
upon  affections  peculiar  to  sex  ;  as  in  the  case  of 
the  family  of  affections  of  the  uro-genital  appara- 
tus which  should  be  divided  into  two  branches, 
(i,)  andrology,   (2,)   gynaecology;   or   upon   the 


*  Family, —  ixovafamilia,  a  family,  and  famulus,  a  servant, 
and  SjxtXta,  an  assembly,  and  the  Hebrew  word  which  means 
to  labor, — is  the  most  general  term,  being  those  who  are 
bound  together  upon  the  principle  of  dependence. 

Family  includes  in  it  every  circumstance  of  connexion  and 
relationship.    (Crabb.) 


248  DEFINITIONS    OF   THE 

affections  of  an  apparatus  which  includes  two,  or 
more  than  two  subsidiary  apparatuses,  as  in  the 
cases  of  the  cephalo-rhachidian,  nutritive,  and 
cutaneous  apparatuses. 

3.  Classes!^ — A  class  of  diseases  is  ordinarily 
defined  as  a  division  of  diseases  grouped  together 
on  account  of  their  common  characteristics.  In 
this  case,  however,  the  term  class  is  used  to 
signify  a  group  of  diseases  which,  though  possess- 
ing different  characteristics,  affect  a  particular 
organ.  In  this  system,  therefore,  the  classes  have 
reference  to,  and  bear  the  anatomical  denomina- 
tion of,  the  organs  of  an  appparatus. 

4.  Orders.^ — Kw  order  is  an  association  of 
genera  or  a  group  of  the  general  morbid  condi- 
tions of  allied  affections  of  particular  organs. 
The  orders,  therefore,   refer  to  the  general  de- 


*  Class,  from  classis  very  probably  from  the  Greek  nXocdii, 
a  fraction,  division,  or  class.  Class  is  more  general  than  order. 
"  Classification  is  a  branch  of  philosophy  which  is  not  attaina- 
ble by  art  only,  it  requires  a  mind  peculiarly  methodical  by 
nature,  that  is  capable  of  distinguishing  things  by  their 
generic  and  specific  differences  ;  not  separating  things  that 
are  alike  ;  nor  blending  things  that  are  different."     (Crabb.) 

t  Order,  from  ordo,  from  opx^'^y  a  row,  which  is  a  species 
of  order,  is  applied  to  everything  which  is  disposed.  The 
order  lies  in  consulting  the  time,  the  place  and  the  object,  so 
as  to  make  them  accord.     (Crabb.) 


TERMS   OF  CLASSIFICATION.  249 

nomination  of  the  morbid  condition  of  the  organs 
of  an  apparatus. 

5.  Genera!^ — A  genus  is  an  assemblage  of  spe- 
cies possessing  certain  characters  in  common. 
The  genera,  therefore,  refer  to  the  particular  de- 
nomination of  the  morbid  condition  of  the  organs 
of  an  apparatus. 

A  single  species  having  distinctive  characters 
that  seem  of  more  than  specific  value  may  con- 
stitute a  genus. 

6.  Species.\ — A  species  is  a  permanent  series  of 
similar  individual  affections  associated  on  account 
of  their  common  properties.  These  properties 
are  to  be  determined  only  by  the  closest  observa- 
tion of  abnormal  conditions  of  the  human  body. 
Species,  says  Cullen,  "  are  ready  made  by  na- 
ture" (he  would  have  been  more  exact  had  he 
said,  the  individual  diseases  which  constitute 
species  are  ready  made  by  nature) ;  the  nosog- 


*  Genus,  from  gignere,  from  yevstv,  to  engender,  "  is  a 
class  of  objects  divided  into  several  subordinate  species." 
(Webster.) 

t  Species,  from  spicere,  to  behold,  signifies  literally  the 
form  or  appearance,  and  in  an  extended  sense  that  which 
comes  under  a  particular  form.  Species  is  a  term  used  by 
philosophers,  classing  things  according  to  their  exiernal  or  in- 
ternal properties."     (Crabb.) 


250  DEFINITIONS  OF  THE 

rapher  has  only  to  discover  and  name  them,  but 
the  orders  and  genera  he  must  construct — not 
according  to  fancy,  but  to  reason  and  to  definite 
rules.  Species  are  therefore  named  in  accordance 
with  the  general  specific  properties  of  the  affec- 
tions of  the  organs  of  an  apparatus. 

7.  Sub-species. — A  sub-species  is  a  subordinate 
species,  possessing  distinctive  characters  that  arc 
of  more  specific  value  than  those  of  a  variety. 
On  this  account  it  occupies  a  middle  position  be- 
tween the  species  and  the  variety. 

8.  Varieties!^ — A  variety  is  a  form  of  species 
possessing  peculiarities  that  differentiate  it  from 
the  typical  characteristics  of  the  species.  The 
varieties  are  therefore  named  in  accordance  with 
the  particular  specific  properties  of  the  affections 
of  the  organs  of  an  apparatus. 

9.  Stib-varieties. — A  sub-variety  is  a  subordinate 
variety  or  a  division  of  a  variety.  It  may  indi- 
cate morbid  properties  differing  in  their  charac- 
teristics from  those  typical  of  varieties,  or  may 


*  Variety,  from  varius  which  probably  comes  from  varus  a 
speck  or  speckle,  because  this  is  the  best  emblem  of  variety. 
Variety  seems  to  lie  in  the  things  themselves.  A  variety  can- 
not exist  without  an  assemblage.  Variety  strikes  on  the 
mind,  and  pleases  the  imagination  with  many  agreeable 
images;  it  is  opposed  to  dull- ««2/ic?rwi/y."     (Crabb.) 


TERMS  OF  CLASSIFICATION.  2$ I 

indicate  the  special  cause  of  the  affection.  The 
sub-varieties,  therefore,  relate  partly  to  the  spe- 
cial character  and  partly  to  the  aetiology  of  the 
affections  of  the  organs  of  an  apparatus. 

10.  Symptoms^' — A  symptom  is  a  manifestation 
of  disease.  It  is  perceptible  to  the  senses,  even 
of  the  patient. 

11.  Signs. — The  sign  of  a  disease  is  the  indica- 
tion of  its  presence.  It  may  be  (i,)  a  sign  per  se, 
indicating  disease  apart  from  symptoms,  or  (2,) 
an  inferential  sign  deduced  from  the  analysis  of  a 
symptom  or  of  a  group  of  symptoms. 

The  symptoms  and  signs,  without  which  ac- 
curate classification  would  be  impossible,  serve  to 
detect  individual  diseases  and  establish  species, 
and  from  the  species  the  classification  is  con- 
structed, for  out  of  them  spring  the  genera  and 
the  orders,  the  varieties  and  the  sub-varieties. 
Therefore  the  position  of  symptoms  and  signs  is 
next  in  order  to  the  fundation  stone  of  no- 
sography. 

Symptoms  of  diseases,  being  their  manifesta- 
tions or  those  phenomena  which  are  apparent  to 
the  senses  of  the  observer  or  even  of  the  patient, 


*  Symptom,  from  6vVf  with,  and  ictjerstv,  to  fall.     To  fall 
in  with.     Any  perceptible  change  in  the  human  body. 


252  TERMS  OF  CLASSIFICATION. 

differ  very  materially  from  the  signs,  these  being 
deduced  from  the  analysis  of  the  symptoms. 
Therefore  the  symptoms  are  noticeable  by  any- 
body, but  unless  rightly  interpreted  are  generally 
of  little  value.  It  is  only  the  wise  and  experi- 
enced physician,  after  analyzing  a  group  of  symp- 
toms and  properly  interpreting  them,  who  can 
perceive  what  is  correctly  termed  the  sign  of  a 
disease.* 


*  The  following  note  is  paraphrased  from  Double's  "  Se?ne~ 
iologie  Generale.  A  collection  of  symptoms  properly  analyzed 
becomes  the  sign  of  a  disease.  The  sign  is  a  conclusion 
which  the  mind  draws  from  the  symptoms  thus  analyzed. 
Therefore  the  sign  belongs  to  the  understanding  and  the 
symptom  to  the  senses.  The  sign  of  a  disease  may  exist  with- 
out symptoms.  It  is  said  by  Fernel  that  all  symptoms  are 
signs  but  that  all  signs  are  not  symptoms.  Symptoms  are 
observed  only  in  disease,  but  there  are  signs  which  belong  to 
health.  It  is  not  generally  said  that  a  man  shows  symptoms 
of  health,  but  that  he  shows  signs  of  health. 


253 


SECTION  V. 

REVIEW  OF  THE  MORBID  STATES  AND  MORBIFIC 

PROCESSES.      THE  BACTERIA,  PTOMAINES, 

LEUCOMAINES,  AND  EXTRACTIVES. 

Analysis  of  some  of  the  terms  used  in  general  pathology 
and  of  those  contained  in  the  synopsis  of  morbid  states  and 
morbific  processes,  together  with  remarks  on  these  stales 
and  processes.  Summary  of  the  present  state  of  knowl- 
edge of  the  bacteria,  ptomaines,  leucomaines,  and  "  extrac- 
tives." The  relations  borne,  to  medicine  and  surgery,  by  these 
microorganisms  and  alkaloids  of  putridity.  Classifications  of 
the  bacteria,  ptomaines  and  leucomaines.  Uniformity  in  their 
nomenclature  and  classification  much  needed.  Remarks  on 
the  neoplasms  and  on  their  classification. 

As  already  stated,  the  synopsis  of  morbid 
states  and  morbific  processes  is  intended  as  a 
suggestion  of  a  ground-work  for  the  classification 
of  diseases,  but  inasmuch  as  new  terms  are 
therein  proffered,  and  changes,  tending  to  greater 
precision,  made  in  many  of  those  that  are  in 
general  use,  some  explanation  is  due  respecting 
the  nature  of  the  new  words  and  the  foundation 
of  the  changes  in  the  old  terms.  Therefore  most 
of  the  terms  contained  in  the  synopsis  will  now 
be  defined,  analyzed  and,  as  far  as  practicable, 
reasons  given  for  their  introduction. 


254  ALTERATIONS   OF  THE   BLOOD. 

In  this  attempt  to  correct  defective  words  and 
to  coin  new  terms,  prefixes  and  terminals  which 
are  in  general  use  will  be  employed,  such  as 
hyper  which  signifies  over,  above,  excess,  and  will 
be  applied  in  the  sense  of  increase,  and  hypo 
which  signifies  under,  below,  and  will  be  applied 
in  the  sense  of  decrease.  The  terminal  aemiay 
from  ai}ia,  blood,  will  be  employed  in  preference 
to  osis  so  often  improperly  used  in  that  connec- 
tion. The  middle  section  of  each  term  com- 
pounded of  three  roots  will  also  be  explained  and 
its  etymology  given  in  a  foot  note. 

I.    ALTERATIONS  IN  THE  QUANTITY,  QUALITY, 
AND  COMPOSITION  OF  THE  BLOOD. 

I.  Hyperaemia*  is  here  used  in  its  strict  signi- 
fication of  a  superabundance  of  blood,  an  in- 
crease of  its  whole  quantity  in  the  body,  and 
is  offered  to  replace  '■'plethora  vera,'  poly- 
aemia,  and  hyperaematosis.  Hyperaemia  has 
often  been  wrongly  employed  to  signify  local 
congestion  or  the  accumulation  of  blood  in  the 
capillary  vessels,  or  even  inflammation.  In  the 
Lexicon  of  Medicine,  etc.,  of  the  New  Sydenham 
Society,  London  1886,  hyperaemia  is  defined  as 


*  vitipt  over,  above,  excess,  and  atjxa,  blood.     Above  the 
normal  amount  of  blood. 


ALTERATIONS   OF  THE    BLOOD.  2$ 5 

*'  an  excessive  amount  of  blood  in  the  vessels  of  a 
part ;  a  local  overfilling  of  the  blood-vessels,  so 
that  they  are  distended  with  blood  and  give  more 
or  less  increased  redness  to  the  part,  with  some 
swelling.  When  hyperaemia  continues  there 
may  be  oedema  of  the  part  from  effusion  of 
serum,  or  there  may  be  haemorrhage."  There  is 
nothing  in  this  definition,  or  rather  description^ 
to  indicate  general  overplus  of  blood.  It  is,  in 
reality,  a  definition  of  congestion  whose  proper 
place  is  under  the  caption  of  disturbances  in  the 
circulatory  apparatus. 

2.  Hypoaemia,*  meaning  an  insufficiency  of 
blood,  a  decrease  of  its  whole  quantity  in  the 
body,  is  introduced  in  place  of  anaemia  which 
literally  signifies  absence  of  blood.  The  inten- 
tion in  the  coinage  of  the  word  anaemia  was  to 
express  the  idea  of  a  lessening  of  the  red  blood 
cells,  and  it  has  failed  to  do  so.  The  privative 
alpha  in  this,  and  in  many  other  words  to  which 
it  is  affixed,  leading  to  misconception  of  the  con- 
dition intended  to  be  designated.  Therefore 
all  w^ords  so  prefixed  should  be  rejected,  except 
where  the  a  is  absolutely  needed,  as  in  atrophy^ 
when  cessation  of  nutrition  is  intended  to  be  ex- 


*  From  vTtOy  under,  beneath,  below,  and  aipta,  blood.    Be- 
low the  normal  amount  of  blood. 


256  ALTERATIONS   OF  THE   BLOOD. 

pressed,  and  in  local  anaemia  when  there  is 
literally  no  blood  in  the  capillary  vessels  of  a 
part;  e.  g.,  local  capillary  anaemia  caused  by 
ischaemia  arising  from  constriction  of  the  capil- 
laries, the  plugging  of  a  neighboring  arteriole, 
etc. 

The  term  hypoaemia  was  formerly  used  to  in- 
dicate the  presence  of  blood  in  the  anterior 
chamber  of  the  eye,  although  there  is  not  a  sylla- 
ble in  this  word  to  show  that  it  has  reference  to 
the  eye.  Hypoaemia  was  also  used  synonym- 
ously with  ecchymosis,  sugillatio.  "Anaemia, 
used  {by  the  French)  S3monymously  with  oligaemia, 
is  a  want,  or  deficiency  of  blood ;  the  condition 
of  the  body  after  great  loss  of  blood;  exsan- 
guinity.  There  may  either  be  a  defect  in  the  to- 
tal quantity  of  blood,  as  occurs  for  a  short  time, 
perhaps,  after  profuse  haemorrhages,  or  a  dimi- 
nution in  the  relative  amount  of  red  corpuscles 
as  compared  with  the  other  constituents  of  the 
fluid,  as  in  chlorosis."  * 

This  mixed  definition,  not  of  anaemia,  but  of 
hypoaemia,  hypoerythrocythaemia,  hyperhy- 
draemia  and  hypohydraemia,  is  very  confused 
and  confusing. 


*  Lexicon  of  Medicine,  etc.  New  Sydenham  Society. 


ALTERATIONS   OF   THE   BLOOD.  25/ 

3.  Hyperhydraemia*  signifies  increase  of  blood- 
water  which  is  not  indicated  by  the  commonly 
used  word  hydraemia  whose  meaning  is  simply 
blood-water,  although  it  has  been  defined,  by 
high  authorities,  "  as  a  watery  condition  of  the 
blood  depending  on  defect  of  albumen  and  fibrin, 
or  on  retention  of  water  from  arrest  of  the  cu- 
taneous or  renal  secretions." 

Hyperhydraemia  is  the  outcome,  of  profuse 
haemorrhage,  exhausting  diseases,  or  starvation. 

4.  Hypohydraemia  signifies  decrease  of  blood- 
water,  and  is  the  outcome  of  those  diseases  in 
which  much  water  is  consumed  in,  or  discharged 
from,  the  body,  as  in  cholera,  erysipelas,  acute 
articular  rheumatism,  puerperal  fever,  typhus 
and  typhoid  fevers,  conditions  producing  poly- 
uria, etc. 

To  express  the  idea  of  deficiency  of  serum  in 
the  blood,  Piorry  adopted  the  term  anhydraemia 
which  means  absence  of  blood-water  and  is  there- 
fore inexact. 

5.  Hyperinosaemiaf  signifies  increase  in  the 
tendency  to  the  formation  of  blood-fibrin,  while 
hyperinosis  indicates  "  over  activity  of  muscular 
fibre."     The  term  hyperinosis  was  suggested  by 


*  ijdoop,  water. 

t  vitep,  excess,  i'i,  i'roi,  muscle,  fibre,  and  at/ia,  blood. 


258  ALTERATIONS  OF  THE   BLOOD. 

F.  Simon  to  express  the  idea  of  "  excess  of  fibrin 
in  the  blood ;  such  as  occurs  in  acute  rheuma- 
tism and  in  erysipelas,  when  it  may  amount  to 
upwards  of  one  per  cent."  But  this,  like  many 
other  imperfectly  constructed  terms,  fails  to  con- 
vey the  intended  idea,  unless  the  final  is  be  re- 
placed by  aemiuy 

6.  Hypoinosacmia  signifies  decrease  in  the 
tendency  to  the  formation  of  blood-fibrin.  Flint* 
uses  the  term  hypinosis  to  signify  imperfect 
coagulation  of  the  blood,  but  it  really  means  de- 
creased activity  of  muscular  fibre. 

Hypoinosaemia  appears  to  be  the  more  exact 
term.  "  It  has  been  observed  in  some  acute 
infectious  diseases,  in  acute  icterus,  in  death 
from  asphyxia,  and  in  death  from  certain  poisons, 
such  as  sulphuretted  hydrogen  and  hydrocyanic 
acid." 

7.  Hyperleucontaemia  signifies  increase  of 
blood-albumen.f  There  being  no  Greek  word 
for  albumen,  the  term  leucontaemia  is  offered  to 
signify  blood-albumen,  from  A.«v«ov,  white  of  Ggg, 
which  is  albumen. 


*  A.  Flint,  Principles  and  Practice  of  Medicine.  1886. 
t  The  substance  formerly  called  albumen  of  the  blood  is  in 
reality  serine  and  metalbumen.     {Flint's  Physiology.) 


ALTERATIONS   OF  THE  BLOOD.  2$^ 

8.  Hypoleucontaemia  signifies  decrease  of 
blood-albumen.  Hypoalbuminosis,  a  hybrid  word 
and  therefore  inadmissible,  has  been  used  ta 
designate  a  deficiency  of  albumen  in  the  blood. 
A  condition  existing  in  starvation  or  after  a  co- 
pious haemorrhage. 

9.  Hyperalonaemia*  signifies  increase  of  blood- 
salts. 

10.  Hypoalonaemia  signifies  decrease  of  blood- 
salts.  These  alterations  in  the  quantity  of  the 
saline  elements  of  the  blood  play  an  important 
part  in  diseases. 

11.  Hyperchromataemiaf  signifies  increase  of 
blood-color.  The  coloring  matter  of  the  red 
corpuscles  of  the  blood  is  called  haemaglobine 
which  is  a  hybrid  word.  It  is  sometimes  dif- 
fused in  the  blood  owing  to  disintegration  of  the 
red  corpuscles,  and  thus  the  blood  is  increased  in 
color.  The  term  haemoglobinaemia  is  used  to 
designate  this  condition,  but  its  composition  ren- 
ders it  hybrid  as  well  as  tautological.  It  is  taken 
from  ai'/iict,  blood,  globulus^  globule,  and  the  term- 
inal ai'fxay  blood.  Hyperchromataemia  seems  to^ 
indicate  clearly  an  increase  in  the  blood-color.   It 


*  vita'py  increase,  ocXi,  aXoov  (genitive  plural),   salt   salts,. 
and  ai'/xa,  blood. 
f  xpoojiioCf  color. 


26o       ALTERATIONS  OF  THE  BLOOD. 

is   for  the   pathoanatomist  and   clinician   to  de- 
termine and  interpret  its  causes  and  effects. 

12.  Hypochromataemia  signifies  decrease  of 
blood-color.  As  there  is  increase,  so,  in  all  prob- 
ability, many  circumstances  arise  to  cause  a  de- 
crease in  the  color  of  the  blood. 

13.  Hyperleucocythaemia  signifies  increase  of 
white  blood-cells.  Leucocythaemia*  is  the  term 
ordinarily  used,  but  it  only  means  white  blood- 
cells,  and  expresses  a  normal  condition.  The 
other  terms,  leucocytosis  and  lukaemia,  sug- 
gested by  Virchow  are  quite  as  indefinite  ;  the 
latter  meaning  white  blood,  which  is  lymph* 
This  eminent  pathoanatomist  adopts  the  word 
leucocytosis  to  express  the  idea  of  a  temporary 
increase  in  the  number  of  white  corpuscles,  but 
the  term  entirely  fails  to  convey  such  an  idea. 
In  the  case  of  a  great  and  permanent  increase  of 
white  blood-cells  he  uses  leucocythaemia  or 
lukaemia,  both  equally  misleading. 

In  hyperleucocythaemia,  the  red  blood-cells 
are  generally  decreased  in  number,  so  that  the 
two  conditions  hyperleucocythaemia  and  hy- 
poerythrocythaemia  occur  in  conjunction. 

Hypoxanthine  has  been  found  in  considerable 


*  Xevxoif  white,  Mvdrti,  pouch,  bag, — cell. 


ALTERATIONS   OF  THE   BLOOD.  261 

quantity     in      cases     of     hyperleucocythaemia. 
(Gamgee,) 

14.  Hypoleucocythaemia  signifies  decrease  of 
white  blood-cells. 

15.  Hypererythrocythaemia*  signifies  increase 
ot  red  blood-cells.  Plethora,t  plerosis, — meaning 
repletion,  and  intended  to  mean  a  superabund- 
ance of  blood  in  the  system  but  failing  to  do  so ; 
hence  the  division  of  plethora  into  general  and 
local, — hyperaemia,  polyaemia,  polycythaemia, 
polyhyperaemia  (!),  angioplerosis,  erythraemia 
(red  blood),  have  all  been  used,  improperl}'-  of 
course,  to  designate  increase  of  red  blood-cells, 

16.  Hypoerythrocythaemia  signifies  decrease 
of  red  blood-cells.  Anaemia  is  generally,  and  im- 
properly, used  to  express  this  condition.  An- 
aemia literally  means  absence  of  blood,  and 
should  be  restricted  to  the  expression  of  the  idea 
of  local  absence  of  blood, — local  anaemia, — such 
as  occurs  in  ischaemia  which  may  be  a  temporary 
or  a  permanent  arrest  of  blood  in  a  part,  the  lat- 
ter arising  from  constriction  of  the  capillaries, 
from  plugging  of  a  neighboring  arteriole,  or 
from  some  other  cause. 


♦  epvQpoS,  red. 

t  Plethora,  from  xXrfBoi,  a  great  number. 


262  ALTERATIONS  OF  THE   BLOOD. 

17.  Hyperlipaemia  signifies  increase  of  blood- 
fat,  and  is  generally  called  lipaemia  (blood-fat),  a 
normal  condition  which  is  very  variable  in  the 
blood-plasma.  It  increases  after  the  ingestion  of 
fatty  substances  until  the  blood  may  acquire  a 
milky  appearance.  Fat  has  been  known  to  in- 
crease in  the  blood  of  diabetics,  in  certain  affec- 
tions of  the  liver,  in  phthisis,  in  chronic  alcohol- 
ism, and  in  fat  embolism. 

18.  Hypolipaemia  signifies  decrease  of  blood- 
fat. 

19.  Hyperphysaemia  signifies  increase  of  blood- 
gas.  The  gases  which  exist  normally  in  the 
blood  are  carbon  dioxyde,  oxygen,  and  nitrogen, 
either  in  solution,  or  in  combination  with  organic 
or  inorganic  compounds.  Their  increase  gives 
rise  to  abnormal  states  which  will  not  here  be 
discussed.  The  reader  is  therefore  referred  for 
further  information  on  this  interesting  subject  to 
Paul  Bert's  experiments,  and  to  works  on  general 
pathology  in  which  are  found  articles  on  the  ef- 
fects of  high  atmospheric  pressure,  air  embolism, 
etc. 

20.  Hypophysaemia  signifies  decrease  of  blood- 
gas.  The  ill  effects  of  this  condition  are  fully 
treated  of  in  the  works  to  which  allusion  has 
been  made  above.     But  a  word   may  be  said  in 


ALTERATIONS   OF  THE   BLOOD.  263 

reference  to  the  effects  of  rarefaction  of  the  at- 
mosphere on  the  respiration  and  on  the  blood, 
such  as  are  felt  during  the  ascent  of  high  moun- 
tains. The  name  of  the  "  mountain  disease  or 
anoxyaemia  "  has  been  given  to  the  condition  of 
individuals  who,  thus  breathing  an  insufficient 
amount  of  oxygen,  take  more  but  shorter  inspira- 
tions than  normally,  suffer  head-ache,  epistaxis 
and  other  haemorrhages,  and  are  soon  overcome 
by  fatigue,  cold,  sleep,  and  in  some  cases  by 
death.  The  same  phenomena  occur  during 
baloon  ascensions.  A  notable  instance  is  re- 
corded by  Tissandier,  sole  survivor  of  three  who 
had  ascended  to  a  great  height  in  the  baloon 
Zenith."^  Jourdanet  has  published  an  interesting 
work,  in  two  volumes,  upon  the  influence  of  at- 
mospheric pressure  on  the  life  of  man,  based 
upon  a  long  experience  and  many  observations 
made  principally  in  Mexico. f 

21.  Hyperglycaemia  signifies  increase  of  blood- 
sugar.  Glycaemia,  blood-sugar,  is  a  normal  con- 
dition. It  is  only  when  the  sugar  exceeds  in 
amount  two  parts  and  a  half  in  one  thousand  of 
blood   that  it  causes   any  disturbance.     It   then 

*  Academie  des  Sciences  25  Avril  1875,  La  relation  de  M. 
G.  Tissandier,  seul  survivant. 

t  Sur  I'influence  de  la  pression  de  I'air  sur  la  vie  de  rhomme» 
Paris  1875. 


264       ALTERATIONS  OF  THE  BLOOD. 

shows  itself  in  the  urine  and  constitutes  what  is 
known  as  glycosuria.  It  arises  from  the  disas« 
similation  of  certain  alimentary  substances. 

22.  Hypoglycaemia  signifies  decrease  of  blood- 
sugar. 

23.  Acetonaemia  signifies  acetone  in  the  bloods 
That  acetone  is  found  in  the  blood  in  connection 
with  disease  is  not  doubted,  but  its  exact  import 
is  still  unsettled.  On  the  other  hand  it  has  been 
asserted  that  ''  acetone  is  a  normal  product  of 
tissue  metamorphosis." 

24.  Ammoniaemia  signifies  ammonia  in  the 
blood.  Ammonium  carbonate  is  formed  in  stag- 
nant, decomposed  urine  in  the  pelves  of  the  kid- 
neys or  in  the  bladder,  and  absorbed  and  carried 
into  the  circulation,  or  may  be  absorbed  from  the 
intestines.  In  cases  of  stagnation  of  urine  in  the 
bladder,  a  bacterial  ferment  is  said  to  have  been 
discovered  which  possesses  the  property  of  con- 
verting urea  into  ammonium  carbonate. 

This  ferment  is  often  introduced  from  without 
through  the  use  of  unclean  catheters. 

"It  was  suggested  by  Frierichs,  in  1852,  that 
uraemic  phenomena  are  due  to  the  conversion  of 
urea  into  ammonium  carbonate  in  the  blood,  but 
there  is  no  ground  for  believing  that  such  conver- 
sion actually  occurs  during  life."     (Gamgee.) 


ALTERATIONS   OF  THE   BLOOD.  265 

25.  Hyperuraemia  signifies  increase  of  blood- 
urea.  Uraemia  means  blood-urea,  but  it  is 
generally  used  in  the  sense  of  accumulation  in 
the  blood  of  the  elements  of  the  urine.  May 
not  the  group  of  phenomena  called  urinary  in- 
toxication be  due  to  the  accumulation  in  the 
blood,  of  acetone  together  with  ammonium  car- 
bonate, urea,  and  other  deleterious  excrementi- 
tious    substances,    such    as    the    "  extractives "  ? 

In  an  experimental  study  of  the  poisonous  prop- 
erties of  the  urine  of  different  animals,  Charrin 
concludes  "  that  the  urea  is  not  the  toxic  agent 
of  the  urine." 

Hyperuraemia  indicates  the  increase  of  a  nor- 
mal constituent  of  the  blood  (urea). 

26.  Hypouraemia  signifies  decrease  of  blood- 
urea. 

27.  Hyperuricaemia  signifies  increase  of  blood- 
uric  acid.  Flint  first  suggested  the  term  uric- 
aemia  which  simply  means  blood-uric  acid,  and 
Murchison  adopted  the  word  lithaemia  (from 
Xi'Qoij  stone),  stone  in  the  blood,  meaning  uric 
acid  in  the  blood  which  is  a  normal  condition. 

A  great  increase  of  uric  acid  in  the  blood  has 
been  observed  by  Garrod  in  the  disease  called 
gout. 


266  ALTERATIONS   OF  THE   BLOOD. 

28.  Hypouricaemia  signifies  decrease  of  blood- 
uric  acid. 

29.  Cholaemia  signifies  bile  in  the  blood.  In 
morbid  conditions  where  the  exit  of  the  bile  from 
the  liver  is  impeded,  the  bile  is  absorbed  by  the 
lymphatics  and  carried  into  the  circulation.  The 
constituents  of  the  bile  creating  certain  toxic  ef- 
fects, and  the  bilirubin  staining  most  of  the  tis- 
sues of  the  body  and  producing  the  condition 
known  as  icterus  or  jaundice. 

30.  Hypercholesteraemia  signifies  increase  of 
blood-cholesterin.  Flint  jr.  asserted,  in  1862, 
*'  that  the  cholesterin  of  bile  is  a  result  of  an  ex- 
cretory function  of  the  liver  not  previously 
recognised,  and  that  it  is  an  excrementitious 
principle  derived  chiefly  from  the  disassimilation 
of  nervous  tissue,"  and  has  given  the  name  of 
cholesteraemia  to  the  accumulation  of  cholesterin 
in  the  blood.  He  attributes  grave  toxic  effects 
to  such  accumulation.  Up  to  the  present  date 
Doctor  Flint  holds  the  same  opinion  on  this  sub- 
ject. Some  of  the  French,  English  and  German 
writers  take  issue  with  Doctor  Flint  in  his  view 
that  hypercholesteraemia  is  capable  of  producing 
the  toxic  effects  attributed  to  "  grave-jaundice." 

31.  Hypocholesteraemia  signifies  decrease  of 
blood-cholesterin. 


SEPTICAEMIA,    PTOMAINES.  26/ 

32.  Melanaemia  signifies  black  pigment  in  the 
blood.  The  different  views  respecting  the  pro- 
duction of  this  condition  will  not  here  be  dis- 
cussed. The  reader  is  therefore  referred  to  works 
on  general  pathology.* 

33.  Septicaemia  f  signifies  putrid  infection  of 
the  blood.  This  is  due  to  infection  of  the  blood 
with  the  poisons  of  putrefied  animal  substances. 
These  animal  poisons  are  now  known  to  be 
alkaloidal,  and  are  named  ptomaines,  from  Tcroo/xa, 
cadaver,  and  zV,  in,  eV,  within,  opposed,  to  e'k 
without.  The  terminal  in,  or  ine,  is  ordinarily 
employed  by  chemists  to  designate  alcaloids. 
There  is  nothing  in  this  etymology  to  denote  an 
alkaloid,  therefore  ptomaine  is  not  a  word  of 
precision. if 

The  ptomaines  may  be  evolved  in  severely  in- 
jured parts  of  the  human  body  followed  by  rapid 
decomposition,  before  suppuration  takes  place, 
or  in  blood  effused   in  the  great  cavities  of  the 


*  There  are  other  changes  in  the  constituents  of  the  blood, 
but  they  are  not  sufficiently  well  known  to  be  here  considered, 

t  From  6r}7tTo<iy  putrid,  and  ai/ia,  blood. 

\  Selmi  derives  ptomaine  "  from  nronfioLy  a  carcase,  a  dead 
body,  and  ivoy  denoting  material ;  or  in,  from  the  Latin  inus 
belonging  to."     But  ivo  does  not  seem  to  mean  material,  and 
even  if  it  should  have  such  a  signification,  material  is  too  ob- 
scure to  designate  alkaloid. 


268  PTOMAINES. 

body  such  as  the  pleura  or  peritoneum,  or  may 
be  ingested  with  food,  and  thus  be  absorbed  and 
infect  the  blood. 

They  are  called  ptomaines  because  of  their 
original  discovery  in  putrid  cadavers. 

As  some  of  the  readers  of  this  work  may  de- 
sire to  study  the  subject  more  extendedly  than  it 
can  be  here  presented,  only  a  brief  account,  with 
some  references,  will  be  given  of  the  discovery 
of  ptomaines,  and  of  the  investigations,  of  their 
nature,  toxic  properties,  and  mode  of  develop- 
ment, now  going  on  in  Europe  and  America. 

Discovery,  in  medicine,  is  generally  slow  and 
gradual,  and  results  from  the  labors  of  many 
men.  The  first  discoverer  may  only  observe  the 
effect,  another  finds  the  cause,  still  another  dis- 
covers the  generic  substance  and  perhaps  its 
properties,  then  investigators  arise  who  discover 
species  and  varieties,  and  finally  come  those 
practical  men  who  are  able  to  interpret  the 
phenomena  directly  or  indirectly  connected  with 
them  and  from  their  analysis  of  these  phenomena 
deduce  the  remedial  means  to  be  taken. 

Ptomaines!^ — The  history  of  the  discovery  of 


*  Doctor  A.  M.  Brown  defines  a  ptomaine,  "  considered 
from  a  purely  chemical  point  of  view,  as  the  cyclical  nucleus 
of  a  proteid  molecule  that  has  undergone  complete  destruc- 
tion in  the  process  of  putrefaction." 


PTOMAINES.  269 

ptomaines  is  a  notable  illustration  of  the  forego- 
ing statement.  In  1822  Gaspard,  and  in  1856, 
Professor  Panum,  of  Copenhagen,  found  putrid 
substances  to  contain  active  poisons  the  nature  of 
which  they  could  not  ascertain.  In  1868,  Berg- 
mann  and  Schmiedeberg  believed  that  they  found 
in  contaminated  blood  a  crystallizable  nitrogenous 
substance,  which  they  called  sepsine  and  which 
they  had  found  in  putrid  yeast.  Their  discovery 
was  contested.  In  1869,  Zeulzer  and  Sonnen- 
schein  are  said  to  have  obtained  from  putrescent 
animal  matter  an  alkaloid  having  the  properties 
of  atropia.  Rosch  and  Fassbender  also  found,  in 
putrescent  animal  matter,  an  amorphous  salt  giv- 
ing reactions  similar  to  those  of  digitaline.  Dupre 
and  Bence  Jones  extracted,  from  the  liver,  a  salt, 
giving  the  fluorescence  of  sulphate  of  quinia, 
which  they  named  animal  chinoidine. 

Professor  Armand  Gautier,  of  Paris,  found,  in 
1872,  that,  while  undergoing  putrefaction,  the 
fibrin  of  the  blood  gave  a  small  quantity  of  com- 
plex alkaloids,  fixed  and  volatile.  The  late  Pro- 
fessor Selmi,  of  Bologna  (1870,  -75,  -78,  -80)  ar- 
rived at  similar  results  in  his  experiments  with 
putrefied  human  tissues,  and  announced  that  un- 
der these  conditions,  toxic  organic  alkalies, 
analogous  to  vegetable  alkalies,  were  formed. 
Since  then  these  substances  have  been  studied, 


2/0  PTOMAINES. 

especially  by  Gianetti  and  Corona  (1880),  Brouar- 
del  and  Boutmy  (1881),  Bouchard  (1882-3),  Gau- 
tier  and  Etard  (1886),  and  Brieger  (1886). 

Ncncki  (1876)  appears  to  have  been  the  first  to 
indicate  the  chemical  formula  of  a  ptomaine. 

Gautier  divides  the  animal  alkaloids  into  two 
distinct  groups,  ptomaines  and  lejicomaines.^  The 
first  are  the  products  of  organic  matter  in  putre- 
faction, the  second,  of  the  living  organism  in 
health  and  in  disease. 

Ptomaines  vary  in  different  phases  of  putrefac- 
tion. Brieger  has  found  successively  in  the  dead 
human  body ;  choline,  neuridine,  cadaverine,  pu- 
trescine,  trimethylamijie^  and  mydaleine.  Besides 
the  above,  Gautier  enumerates  the  following 
ptomaines  ;  parvoline^  hydrocollidine,  collidine,  and 
saprine. 

These  alkaloids  are  evolved  through  microbic 
fermentation  generally  after  death  ;  but  are  more 
or  less  toxic  when  ingested  with  food. 

In  a  recent  article,  Professor  Vaughan,  of  the 
University  of  Michigan,  divides  the  ptomaines 
into  two  classes;  (i,)  those  containing  oxygen: 
(2,)  those  containing  no  oxygen.     *'  Among  the 


*  Gautier  gave  to  the  alkaloids  of  the  human  organism  the 
name  of  leucomaines  "  to  indicate  their  albumenoid  origin." 


PTOMAINES.  271 

most  important  members  of  the  second  class  are 
the  following : 

1.  '' Collidine — Cs  Hn  N,  discovered  by  Nencki 
in  1876,  in  gelatine  allowed  to  putrefy  with  infu- 
sion of  pancreas. 

2.  "  Parvoline — Cb  H13  N,  discovered  by  Gau- 
tier  in  1 88 1,  as  a  product  of  the  putrefaction  of 
fish.  Parvoline  is  an  oily  base,  of  amber  color 
and  boils  at  200°  C.  It  is  slowly  soluble  in  wa- 
ter, freely  soluble  in  ether,  alcohol  and  chloro- 
form. 

3.  "  Hydrocollidine — Ce  Hia  N,  discovered  by 
Gautier  and  Etard  in  1882,  also  from  putrid  fish. 
It  is  an  oily  liquid,  boiling  at  210°  C.  It  is  very 
poisonous,  seven  milligrammes  being  sufficient 
to  kill  a  pigeon.  Death  is  preceded  by  nervous 
excitement  and  tetanic  convulsions. 

4.  ''Base — Ci7  H38  N4,  discovered  by  Gautier 
and  Etard  in  1882.     It  is  not  poisonous. 

5.  "■  Base — Cio  Hi  N,  discovered  by  Guareschi 
and  Mosso  in  1883,  in  putrid  beef.  It  is  not 
poisonous,  or  is  so  only  in  very  large  quantity. 

6.  '*  Neuridine — Ce  Hi4  Na,  discovered  by 
Brieger  in  1884.  It  is  wholly  inert,  and  its  im- 
portance depends  upon  its  presence  in  nearly  all 
putrid  matter  and  upon  the  fact  that  it  gives  all 


2/2  PTOMAINES. 

the  general  alkaloidal  reactions,  and  for  this 
reason  may  be  mistaken  for  some  vegetable 
poison  by  the  toxicologist. 

7.  "  Tyrotoxicon'^ — Cs  Hs  N2,  discovered  by 
Vaughan  in  1885,  in  poisonous  cheese,  and  found 
by  himself  and  others  later  in  milk,  ice  cream, 
custard,  cream  puffs,  etc.  This  is  a  highly  poison- 
ous body,  producing  nausea,  vomiting,  collapse 
and  death. 

8.  "■  Cadaverine — Cs  Hia  N,,  discovered  by 
Brieger  in  the  cadaver.     It  is  inert 

9.  '' Putrescine- — C*  H12  Na,  also  discovered  by 
Brieger,  is  not  poisonous. 

10.  "  Mydaleine, — The  chemical  composition  of 
this  ptomaine  has  not  been  determined.  It  di- 
lates the  pupils  and  elevates  the  temperature 
from  1°  to  2°  when  injected  under  the  skin. 

*'  Among  the  oxygen  containing  ptomaines,  the 
most  important  are  : 

I.  '^  Neurine — Cs  His  NO,  contracts  the  pupil, 
lessens  the  respirations,  hastens  the  action  of  the 
heart,  causes  profuse  diarrhoea  and  the  involun- 
tary emission  of  urine. 


*  See  the  Report  of  Doctor  Vaughan  to  the  Michigan  State 
Board  of  Health  for  1885. 

According  to  Gautier  putrid  cheese  yields  neuridine. 


PTOMAINES.  273 

2.  "  Choline — Cs  Hib  NO2,  is  found  in  small 
quantity  in  the  bile  as  well  as  in  putrid  matter. 
It  is  less  powerful  in  action  than  neurine,  which 
it  resembles. 

3.  '*  Gadiymie — O  Hia  NO2,  discovered  by 
Brieger,  is  not  poisonous." 

Doctor  A.  M.  Brown*  arranges  the  ptomaines 
into  "■  two  classes,  the  non-oxygenous  and  oxy- 
genous. The  first  come  from  the  pyridic  bases 
of  Gautier,  or  those  ptomaines  which,  besides  be- 
ing the  most  abundant,  persist  throughout  the 
whole  of  the  putrefactive  process." 

"  NON-OXYGENOUS  ALKALOIDS. 

1.  ''  Par vo line y  C9  H13  N. — This  was  the  first 
ptomaine  chemically  analysed  and  defined.  It 
was  discovered  by  Gautier  and  Etard  in  the 
putrefactive  products  of  the  mackerel  and  horse 

flesh It  is  described  by  them  as  an  oily 

base 

2.  '' Hydro-Collidine,  Cs  H  3  N. — This  base  has 
also  been  obtained  from  the  putrefactive  pro- 
ducts  of  the  mackerel  and  horse,  and  even   ox 


*  A  treatise  on  the  animal  alkaloids,  cadaveric  and  vital ;  or 
the  ptomaines  and  leucomaines,  etc.  London,  1887,  p.  31 
et  seq. 


274  PTOMAINES. 

flesh it  is  very  poisonous,  even  in  very  small 

quantities. 

3.  ''Base,    Ci7    Hse     N*. — The     analysis 

which  Gautier  and  Etard  have  made  of  this 
chloroplatinate  enables  them  to  establish  the 
formula  C17  Hxs  N4  2  H  CI. 

4.  "  Base,  Cio  His  N. — This  ptomaine  was  dis- 
covered in  1883,  by  Guareschi  and  Mosso,  who 
isolated  it  by  the  Gautier-Etard  method  from  the 

putrid  fibrine  of  the  bullock It  has  also 

been  detected  among  the  basic  products  arising 
from  the  putrefaction  of  cephalopod  pulps 

5.  "  Collidine,  Cs  Hn  N. — Was  extracted  by 
Nencki,  in  1876,  from  the  putrefactive  products 

of gelatine  and of  bullock  pancreas, 

{mixed  with  water) 

6.  ''  Neuridine,  Ce  H14  N2.  — This  base  is  one  of 
the  most  constant  products  of  the  putrefaction  of 
albumenoid  substance.  The  ptomaine  was  dis- 
covered in  1884  hy  Brieger,  who  has  since  de- 
tected it  in  the  putrescent  matters  of  flesh,  fish, 

decaying    cheese,    etc Chemically    pure 

neuridine  is  not  toxic. 

7.  "  Cadaverine,  Ce  Hn  Na. — In  bodies  subjected 
to  prolonged  putrefaction,  Brieger  has  met  with 
a  base  of  very  difficult  purification,  to  which  he 
has  given   the  name  of   cadaverine.     Boeckersh 


PTOMAINES.  275 

has  separated  it  from  herring  brine,  and  quite  re- 
cently— 1884 — the  alkaloid  has  been  detected  in 
marine  cephalopod  pulp.  The  ptomaine  is  not 
toxic. 

8.  ''  Putre seine,  C*  H12  N2. — Like  the  preceding 
ptomaines,  it  is  obtained  from  the  flesh  of  the 
mammifera,  and  from  herring  brines.  It  is  not 
toxic. 

9.  ''  Mydaleme. — In  the  mother  liquors  from 
which  the  preceding  bases  have  been  isolated 
owing  to  the  varying  solubility  of  their  platini- 
chlorides,  there  remains  a  toxic  alkaloid  which 
has  also  been  isolated,  but  in  too  small  quantities 
to  permit  of  its  complete  study.  The  analysis  of 
it  is  suggestive  of  a  diamine  similar  to  those  we 
have  been  dealing  with ...... 

"OXYGENOUS  ALKALOIDS. 

"  These  bases  serve  as  the  connecting  link  be- 
tween the  ptomaines  and  the  leucomaines.  With 
the  exception  of  gadinine  they  are  to  be  met  with 
in  the  normal  tissues  as  well  as  in  putrescent 
animal  materials. 

(C  Hs)  \ 
I.  "  Neurine,  Q,  Hi,  N  (O  H)=  N  O  H. 

Ca  Hs  y 

*'  Hydrate  of  trimethylvinylammonium. 


276  PTOMAINES. 

"  It  is  known  that  the  breaking  up  of  a  complex 
compound  with  a  watery  solution  of  baryta,  the 
lecithine  present  in  the  animal  economy,  by  tak- 
ing- up  or  fixing  the  water,  furnishes  besides 
phosphoglyceric  and  stearic  acids,  and  a  base 
choline  Cs  His  NO2  the  synthesis  of  which 
Wurtz  effected  in  treating  trimethylamine  with 
oxyde  of  ethylene  in  the  presence  of  water 

C   Ha\  (C     H3)3      x 

0+  (C  H3)3  N  +  Ha  0=  N.  O  H 

C  H2/  Ca  H4  O  H/ 

"  This  synthesis  characterises  choline  as  the 
hydrate  of  trimethylhydroxethylene — ammon- 
ium. Treated  with  hydriodic  acid,  choline  is 
converted  into  an  iodide  of  iodethylene-trimythyl- 
ammonium 

(C      H3)3       \  (C  H3)  3  \ 

N.  0H  +  2HI  =  2H20+  NI. 

Ca  H4  O  H  /  Ca  H4  I  / 

"  The  oxyde  of  silver  transforms  this  latter 
body  into  a  new  base  neurine  which  is  a  hydrate 
of  trimethylvinylammonium 

(C   H8)3      \  (C   H3)3     \ 

N.  I  +  Ag  2  O  =  2  Ag  I  +  N.  O  H. 

C2  H4  I     /  Ca  Ha     / 

"  This  is  the  neurine  that  has  been  met  with  by 
Brieger  in   the  products  of  cadaveric  putrefac- 


PTOMAINES.  277 

tion,  when  it  arises  from  the  breaking  up  of 
lecithine.  It  is  a  syrupy  base  soluble  in  water  in 
any  proportion,  strongly  alkaline ;  its  chloro- 
platinate  well  crystallised  may  be  removed  from 
the  mother  liquors  of  the  neuridine.  This  base 
is  toxically  interesting. 

(C       H3)3  X 

2.   ''  Choline,  Cb  H15  N  O,  =  N.  O  H. 

C2  H4— O  H  / 

Hydrate  of  trimethylhydroxethylenine — am- 
monium. 

"  It  is  Strieker  who  has  isolated  this  body  from 
the  bile.  It  is  distinguished  from  neurine  by  the 
composition  and  formula  of  constitution  as  given 
above.  The  choline  is  a  base  which  is  elaborated 
both  during  normal  life  of  the  tissues,  and  during 
their  bacterial  destruction,  and  is  therefore,  both 
ptomaine  and  leucomaine.  Brieger  has  isolated 
it  by  crystallising  in  the  form  of  picrate  of  choline 
in  the  mother  liquors  from  which  he  derives  the 
neurine 

Choline  is  less  toxic  than  neurine. 

3.  "  Muscarine,  Ce  H13  N  Os,  was  discovered  by 
Schmiedeberg  and  Koppe  in  the  toadstool — 
agaricus  muscarius.  Schmiedeberg  and  Hartnack 
have   accomplished   its   synthesis    by   oxydising 


278  PTOMAINES. 

choline  with  nitric  acid  ;  this  permits  muscarine 
to  be  regarded  as  an  aldehydic  alkaloid. 

(C     H8)8        X 

N  O  H. 

**  Brieger  has  isolated  it  along  with  ethylene- 
diamine  in  putrid  fish  meat.  Muscarine  is  found 
present  in  the  mother  liquors,  in  which  the 
chloride  of  platinum  has  precipitated  the  ethy- 
lene-diamine  

Muscarine  is  a  violent  poison. 

4.  "  Gadinine,  O  Hie  N  O2. — Brieger  obtains 
this  body  at  the  same  time  and  along  with  the 
preceding  base  from  the  cod-fish — gadus  callarius 
— in  process  of  putrefaction.     This  alkaloid  has 

not  been  isolated  in  a  free  state Its  salts 

are  not  toxic. 

5  and  6.  Bases,  C»  His  N^  Oe,  and  O  Hx,  Na  O4. 
— Pouchet  has  published  since  1880,  quite  a 
series  of  interesting  works  on  the  ptomaines.  He 
endeavours  to  isolate  by  a  somewhat  similar 
method  to  that  of  Stas  and  Drugendorff,  the 
alkaloids  of  the  residuary  liquors  resulting  from 
its  industrial  treatment  of  bones,  flesh,  and  debris 
of  every  kind,  by  dilute  sulphuric  acid 

"  In  the  course  of  his  researches,  Brieger  has 
detected    other    alkaloids    still  less    defined   or 


PTOMAINES.  279^ 

simply  indicated,  which  are  having  now  his  care- 
ful study " 

brieger's  nomenclature. 

The  following  table  is  arranged  after  Brieger's 
nomenclature;  the  several  ptomaines  occupy  the 
relative  positions  in  which  they  appear  in  the 
French  translation  of  his  work.* 

I.  Ptomaine  of  peptone. 
I.  Peptoxiyie. 

II.  Ptomaines  of  putrefied  meat. 

1.  Neuridine 

2.  Neiirine 

3.  Choline. 

III.  Ptomaines  of  putrefied  fish. 

1.  Ethylene-diamine 

2.  Animal  muscarine 

3.  Gadinine 

4.  Triethylamine. 

IV.  Ptomaines  of  putrefied  cheese. 

1.  Neuridine 

2.  Trimethylamine. 


*  L,  Brieger,  Microbes,  ptomaines  et  maladies.  Ouvrage 
tradnit  de  I'Allemand  par  les  Docteurs  Roussy  et  Winter^ 
Paris,  1887. 


2So  PTOMAINES. 

V.  Ptomaines  of  putrefied  gelatine. 

1.  Isophenyl-ethylamiyie  of  Nencku 

2.  Neiiridine  of  gelatine 

3.  Dhnethylamirie. 

VI.  Ptomaine  of  putrid  yeast. 
I.  Dimethylamifie  of  yeast. 

VII.  Ptomaines  of  the  human  cadaver. 

1.  Choline 

2.  Neuridine 

3.  Cadaverine 

4.  Putrescine 

5.  Saprine 

6.  Trimethylamine 

7.  Mydaleine, 

When  putrefaction  occurs  at  a  low  tempera- 
ture the  toxic  alkaloids  are  developed  slowly,  and 
^ice-versa. 

In  the  different  states  of  putrefaction  of  human 
•cadavers,  Brieger  has  found  ptomaines  which 
disappear  to  be  replaced  by  others.  Lecithine^ 
which  exists  normally,  is  followed  by  choline^ 
then  other  alkaloids  are  elaborated.  On  the 
•second  day  neuridine^  which  is  accompanied  by 
choline,  is  found.  The  choline  soon  begins  to 
disappear  in  favor  of  trifnethylamijte.  The  neurid- 
ine  then  increases ;  the   greater   quantity  being 


PTOMAINES.  281 

furnished  by  the  intestines,  the  large  parenchy- 
matous organs  containing  but  little  of  this  salt. 
On  the  seventh  day  of  putrefaction  the  choline 
disappears  while  the  neuridine  lasts  until  the 
fourteenth  day.  For  two  days  after  the  beginning 
of  putrefaction  there  is  no  poison  as  the  first  two 
alkaloids  are  not  toxic.  Cadaverhie  increases  dur- 
ing the  whole  process  of  putrefaction.  With 
cadaverine,  putreschie  and  saprine  are  ordinarily 
found.  Choline  and  trimethylamine  are  not  toxic 
except  in  large  quantity.  The  really  strong 
poisons  are  not  developed  until  fifteen  days  from 
the  beginning  of  putrefaction.  Mydaleine  is  not 
developed  until  three  weeks.  It  is  the  most  toxic 
of  all  the  alkaloids.  Injected  in  small  quantity  into 
guinea-pigs  and  rabbits,  it  causes  inflammation  of 
the  mucous  membranes,  dilatation  of  the  pupils, 
and  increase  of  the  body  temperature.  An  mjec- 
tion  containing  half  a  centigramme  of  mydaleine 
caused  the  sudden  death  of  a  cat.  It  gives  rise  to 
profuse  diarrhoea  and  vomiting.     (Gautier). 

Nicati  and  Rietsch  have  obtained,  from  pure 
cultures  of  the  cholera  bacillus,  a  ptomaine 
which,  they  say,  produces  symptoms  of  cholera 
when  injected  into  the  body  of  an  animal. 

Gautier  says  that  the  typhoid  fever  bacillus  of 
Eberth  does  not  cause  putrefaction,  but  that  the 
liquids  in  which  it  has  lived  contain  a  trace  of  a 


282  PTOMAINES. 

base  which  possesses  the  property  of  dilating  the 
pupils,  and  causes  diarrhoea,  and  very  soon 
death. 

From  cultures  of  the  tetanus  bacillus,  growing- 
in  connection  with  a  non-pathogenic  organism 
from  which  it  has  not  yet  been  freed  in  pure  cul- 
tures, Brieger  has  separated  a  ptomaine  which  he 
calls  tetanin,  and  which,  injected  hypodermically, 
produces,  in  animals,  symptoms  similar  to  those 
induced  by  inoculation  with  the  organisms  them- 
selves, namely  symptoms  of  tetanus.*  (Com- 
municated by  Doctor  Prudden). 

Brieger  has  "  obtained  from  mussels,  (i,)  a  non- 
poisonous  substance;  (2,)  a  substance  which  is 
isolated  by  means  of  platinum  chloride,  and 
which  produces  energetic  salivation  and  diar- 
rhoea ;  (3,)  the  specific  virus,  which  combines 
only  with  the  tetrahedral  platinum  chloride.  It 
possesses  the  characteristic  properties  of  curare  ; 
(4,)  an  analogous  body,  probably  a  decomposi- 
tion-product. It  is  an  energetic  poison  and  occa- 
sions shiverings.  Non-poisonous  mussels,  if 
brought  in  from  the  offing  and  deposited  in  the 
harbor,  become  poisonous,  but  lose  this  property 
again  if  returned  to  the  open  sea.  (Is  the  de- 
velopment of  the  poisonous  principles  occasioned 


*  Deutsche  Med.  Wohenschr.  Apl.  14th,  1887,  p.  303. 


PTOMAINES.  283 

by  the  mussels  feeding-  npon  sewage-matters?"*) 

Carles  has  discovered  in  decayed  salt  cod-fish  a 
red  micrococcus,  and  describes  the  condition  un- 
der the  name  of  red  stock-fish. 

Gautier  asserts  that  putrid  fish  yields  a  poison 
which  has  the  same  composition  and  action 
as  muscarine. 

Gautier  desiring  to  ascertain  if  the  saliva  of  the 
higher  orders  of  animals  contains  a  poison  similar 
to  the  venom  of  serpents,  found,  in  the  saliva  of 
man  a  toxic  alkaloid  which  narcotises  birds.  This 
alkaloid,  he  says,  resembles  cadaveric  alkaloids^ 
is  soluble  in  water,  is  not  an  albumenoid  and  is  in^ 
destructible  by  a  heat  of  212". 

The  study  of  ptomaines  is  of  very  great  im- 
portance alike  in  chemistry,  pathology  and  legal 
medicine.  Particularly  in  the  last  named  depart-^ 
ment  of  medicine,  when  it  is  considered  that 
most  of  the  ptomaines  are  liable  to  be  mistakeit 
for  such  vegetable  alkaloids  as  strychnia,  vera- 
tria,  nicotia,  hyoscyamia,  atropia,  etc. 

The  body  of  a  man  w^ho  has  died  from  the  ef- 
fects of  a  poison  does  not  contain  ptomaines  until 
decomposition  has  been  fairly  established,  but  the 
ptomaines  are  found  under  the  same  condition  of 


*  Chemical  News,  June  1886. 


-284  PTOMAINES. 

putrefaction  when  the  cause  of  death  is  other 
than  poison. 

Doctors  Brouardel  and  Boutmy  report  that 
having  analyzed  the  viscera  "  of  a  person  asphyx- 
iated by  charcoal  fumes,  they  found  them  free 
from  poison.  Eight  days  later  the  same  viscera 
were  again  subjected  to  analysis  and  found  to 
contain  a  solid  organic  base  presenting  the  gen- 
eral characteristics  of  alkaloids,  and  toxic  enough 
to  kill,  even  in  small  doses,  frogs  and  guinea  pigs. 
This  shows  that  putrefaction  gives  rise  to  organic 
-alkaloids  when  no  poisoning  has  taken  place." 

On  another  occasion  they  "  found  a  venenous 
ptomaine  in  a  subject  poisoned  by  arsenious  acid, 
thereby  agreeing  with  Professor  Selmi  who,  in 
1873,  met  with  the  same  ptomaine  in  two  subjects 
also  poisoned  by  arsenic.  Hence  it  is  seen  that 
ptomaines  will  form  as  well  in  subjects  who  come 
to  their  death  without  poison,  as  in  those  who 
died  from  the  ingestion  of  a  poison,  like  arsenic, 
possessing  strong  antiseptic  properties." 

Some  of  the  ptomaines  are  very  poisonous  to 
man  when  ingested  with  food.  An  illustrative 
case  of  ptomaine  poisoning  is  related  as  follows  : 
*'  Twelve  persons  who  had  eaten  a  tainted  goose 
containing  an  alkaloid  resembling  conia,  offered 
all  the  symptoms  of  dangerous  poisoning.  One 
of  them  even  died  in  a  few  hours,  after  copious 


PTOMAINES.  285. 

vomitings,  although  no  other  cause  of  death  but 
the  presence  of  ptomaine  could  be  detected^ 
Hence  it  may  be  concluded  that  ptomaines  can 
cause  the  death  of  man  as  well  as  of  animals — as 
they  are  known  to  do.  Much  time  is  not  neces- 
sary for  the  formation  of  these  alkaloids,  for  the 
goose  above  mentioned  had  been  bought  at  the 
market  on  the  very  morning  of  the  poisoning  ac- 
cident, and  had  passed  the  regulation  inspec- 
tion." 

This  should  be  a  warning  to  those  who  have 
acquired  a  taste  for  what  is  called  *'  high  game," 
which  is  game  in  a  more  or  less  advanced  state 
of  decay  and  in  which  ptomaines  have  already 
been  formed. 

The  reported  cases  of  poisoning  ascribed  to 
eating  partridges  that  were  supposed  to  have  fed 
on  the  cocculus  indicus  or  fish-berry,  were,  in  all 
probality,  ptomaine  poisoning. 

Doctor  Lauder  Brunton,  of  London,  cautions 
the  people  against  the  indiscriminate  use  of  the 
digestive  ferments  and  of  artificially  digested 
foods  as  likely  to  contain  poisonous  alkaloids. 
This  caution  may  be  extended  to  the  case  of 
canned  foods. 

The  existence  of  ptomaines  has  been  denied, 
but  the  weight  of  evidence  is  overwhelmingly 
in  favor  of  their  formation  in  putrid  animal  mat- 


2S6  LEUCOMAINES. 

ter.  Some  of  them  are  said  to  be  very  noxious, 
while  others  possess  scarcely  any  toxic  proper- 
ties. They  are  not  developed  until  putrefaction 
is  established,  therefore  refrigeration  of  the  body 
has  been  recommended  as  the  simplest  means  of 
retarding  decomposition  in  case  a  medico-legal 
investigation  should  be  necessary  to  establish  the 
presence  or  absence  of  poison  in  the  body. 

A  case  in  point,  is  related,  of  a  sudden  death, 
where  there  were  suspicions  of  poisoning.  Doc- 
tor Brouardel,  who  had  charge  of  the  inquiry, 
caused  the  body  to  be  immediately  conveyed  to 
the  Paris  Morgue  for  refrigeration.  An  examina- 
tion was  duly  made  and  no  poison  was  found  in 
the  body.  Had  decomposition  begun,  a  doubt 
would  have  arisen,  and  its  solution  would  have 
been  very  difficult  if  not  impossible  if  a  ptomaine 
ihad  been  found  and  could  not  be  easily  dis- 
tinguished from  a  poisonous  vegetable  alkaloid. 

Leucomaines. — There  have  been  many  differences 
of  opinion  respecting  the  origin  of  leucomaines. 
According  to  Bouchard,  alkaloids  are  found  in 
animal  matter  where  microscopic  mushrooms 
live  and  swarm  ;  and  he  regards  them  as  pro- 
ducts of  the  disintegration  of  vegetable  or- 
ganisms. He  thinks  that,  if  these  bacteria,  living 
in  animal  matter,  manufacture  alkaloids,  it  may 
be  asked  if  other  bacteria,  swarming  in  a  living 


LEUCOMAINES.  287 

organism  may  not  produce  analogous  substances. 
To  verify  this  supposition  he  examined  the  urine 
of  patients  affected  with  infectious  diseases  and 
constantly  found  therein  some  of  these  alkaloids. 
However,  distinct  traces  of  such  alkaloids  are 
found  in  the  urine  of  healthy  persons,  but  this 
does  not  prove  that  they  are  not  developed  from 
forms  of  vegetable  organisms.  It  was  long  ago 
shown  that,  in  health,  there  are  great  quantities 
of  microbia  in  the  alimentary  canal ;  this  being 
the  case,  alkaloids  may  be  formed  in  the  intes- 
tines, absorbed,  and  finally  eliminated  with  the 
urine. 

Bouchard  has  shown  that  all  recent  fecal  mat- 
ter contains  alkaloids  in  amount  proportionate  to 
the  quantity  to  microbia,  and  formulates  the  fol- 
lowing propositions  : 

1.  Alkaloids  exist  in  the  healthy  human  body  ; 

2.  They  are  manufactured  in  the  digestive 
tube,  and  are  apparently  elaborated  from  vegeta- 
ble organisms,  agents  of  intestinal  putrefaction  ; 

3.  The  alkaloids  of  normal  urine  represent  a 
part  of  the  alkaloids  of  the  intestines,  absorbed 
into  the  system  and  eliminated  by  the  kidneys  ; 

4.  Diseases  which  tend  to  increase  intestinal 
putrefactions,  augment,  by  this  process,  the 
amount  of  the  urinary  alkaloids. 


288  LEUCOMAINES. 

5.  While  regarding  as  probable  that  these 
alkaloids,  in  certain  infectious  diseases,  have  for 
origin  the  microbia  infesting  the  solids  and  fluids, 
it  may  be  positively  asserted  that,  in  typhoid 
fever  especially,  a  part,  at  least,  of  the  urinary 
alkaloids  are  intestinal  products. 

According  to  Gautier,  leucomaines  are  only  in 
part  the  products  of  bacterian  ferments.  He  has 
shown  that  they  do  not  all  spring  from  this 
source  for,  he  and  others  have  found  that  the 
body  contains  the  following  named  crystallizable 
alkaloids ;  Karniney  Adenine,  Guanine ,  Sarkine^ 
Xanthocreatinine,  Crusocreatinine,  Amphicreatinine^ 
Xanthine,  and  Pseudoxanthine,  besides  the  "extrac- 
tives" which  are  very  toxic.  He  accounts  for 
their  development  as  follows :  he  has  demon- 
strated that  the  higher  animals  are  anaerobic  * 
in  a  considerable  proportion,  and  it  is  now 
acknowledged  that  nearly  two  tenths  of  man's 
disassimilations  are  produced  at  the  expense  of 
the  tissues  themselves  without  any  aid  of  oxy- 
gen ;  the  tissues  living,  in  part,  after  the  manner 


*  The  terms  aerobia  and  anaerobia,  were  proposed  by 
Pasteur  to  designate  two  classes  of  low  organisms.  The 
former  incapable  of  living  without  free  oxygen,  and  the  latter 
multiplying  itself  indefinitely  without  the  aid  or  presence  of 
oxygen. 


LEUCOMAINES.  289 

of  anaerobic  or  putrid  ferments ;  the  animal  cells 
are  then  comparable,  by  their  action  on  organic 
matter,  to  bacteria,  and  in  their  products  of  dis- 
assimilation  should  be  found  the  same  substances 
as  in  the  products  of  putrid  fermentation  of  the 
albumenoids.  These  alkaloids  have  been  found 
not  only  in  the  urine,  but  in  the  blood,  in  the 
saliva,  etc. 

In  a  physiological  state,  these  poisons  are 
eliminated  by  the  kidneys,  skin,  and  alimentary 
canal,  when  they  have  not  been  consumed  by  the 
oxygen  of  the  blood,  for  they  are  ordinarily  very 
oxydizable. 

When  the  aeration  of  the  blood  is  imperfect, 
leucomaines  or  substances  of  their  nature  accu- 
mulate in  the  blood  and  give  rise  to  morbid 
processes.  Along  with  these  substances  there  are 
others  (the  "  extractives  "  ),  equally  nitrogenous 
but  not  alkaloidic,  which  always  accompany  them 
and  are  endowed  with  still  greater  toxic  proper 
ties.  If  the  elements  of  the  tissues  can  act  as  do 
microbia  and  engender,  like  them,  toxic  products, 
it  should  be  admitted  that  certain  infections  are 
not  heterochtonous.  The  action  of  these  poisons 
differs  from  that  of  animated  beings  by  the  fol- 
lowing characters  : 

I.  They  act  only  when  they  are  found  in  ap- 
preciable quantity  in  the  organism. 


290  LEUCOMAINES. 

2.  Their  consequences  have  an  intensity  pro- 
portionate to  quantity. 

3.  These  consequences  are  almost  immediate, 
there  being  no  incubation. 

Gautier  thinks  that  an  appreciable  distinction 
may  be  made  between  bacterial  and  autochtonous 
alkaloids.  But  other  observers  entertain  the  be- 
lief that  it  is  not  possible  in  the  present  state  of 
knowledge  of  the  subject  to  indicate  the  precise 
point  where  the  former  series  ends  and  the  latter 
begins,  for,  some  of  them  are  common  to  both 
types. 

Doctor  A.  M.  Brown  has  arranged  the  leu. 
comaines  as  follows  : 

"  I.  The  Uric  Leucomaine  Group. — 
Betaines. 

Betaine  is  the  representative  of  this  group,  hav- 
ing the  chemical  formula  of 

(C  H3),  =  N  —  O 
a  Hii  N  Oa  =  I 

C  Ha  —  C  O. 

"  The  base  was  originally  discovered  in  beet- 
root in  1866  by  Scheifler,  and  in  1869  Liebreich 
detected  its  presence  in  human  urine. 

I.  Karnine^  O  Ha  N4  Os. — Commences  the 
natural  series  of  alkaloids  of  the  urine  groups. 
The  base  was  isolated   from  imported  meat  by 


LEUCOMAINES.  29I 

Weidel,    and    afterwards    in    yeast    waters    by 
Schutzenberger. 

2.  Adenine,  C»  H*  N*. — Discovered  by  Kossel 
in  1885. 

3.  Guanine,  Cb  Hs  Ns  O. — Discovered  in  1884 
by  Unger,  and  since  met  with  in  a  great  number 
of  products  of  animal  nature ;  in  the  flesh,  the 
organs  and  the  excremental  matters  of  certain 
mammifera,  in  fowls,  and  fish,  and  also  in  certain 
plants. 

4.  Sarkine  or  hypoxanthine,  Cs  H*  N*  O. — Found 
in  certain  plants,  but  for  the  most  part  in  animal 
tissues. 

5.  Xanthine,  Cb  H4  N4  O*. — Is  widely  distrib- 
uted in  the  organism,  in  almost  all  the  liquids  and 
tissues  of  the  animal  economy  from  the  splitting 
up  of  neucleine.  The  base  was  first  isolated  by 
Marcet  in  18 19. 

6.  Fseudo-xanthine,  C*  He  Ns  O. — Discovered 
by  Gautier  in  the  muscular  tissue  of  the  higher 
animals. 

*'  These  last  four  leucomaines  form  a  distinct 
group,  as  to  community  of  origin,  with  analogous 
chemical  properties  : — (i,)  They  all  possess  a  com- 
bination (C5  H4  N4)  of  a  remarkable  stability, 
analogous  in  certain  respects  to  the  stability  of 
pyridic  compounds.     (2,)  They  can  all  give  up 


292  LEUCOMAINES. 

cyanhydric  acid,  and  two  of  them,  xanthine  and 
hypoxanthine,  may  be  obtained  synthetically  in 
operating  with  the  same  cyanhydric  acid.  (3,) 
All  of  them  are  derived  from  albumenoid  sub- 
stances by  reactions  which  are  identical  in  origin. 
(4,)  Three  of  them  present  in  a  high  degree  that 
insolubility  in  water  which  the  pyridic  com- 
pounds exhibit. 

''  Hydrocyanic  acid  forms  the  chemical  skeleton 
of  that  cellular  nucleus  which  is  the  most  active 
phenomenon  of  vitality. 

•'  II.  The  Kreatinine  Leucomaine  Group. 

1.  That  well  known  base,  Kreatinine^ 

NH CO 

C4  Ht  Ns  O  N  H  =  C  I 

N  (C  Ha)  —  C  H, 

heads  the  list  of  the  other  new  alkaloids  dis- 
covered by  Gautier  since  1881.  They  are  all  of 
fresh-meat  origin.  Kreatinine  was  discovered  by 
Liebig  in  the  action  of  chlorohydric  acid  on 
Kreatine,  and  Pettenkofer  afterwards  found  it  in 
human  urine. 

2.  Xantho-creatinine,  C»  Hio  N4  O. — The  most 
abundant  of  these  bases,  is  of  cadaveric  odour, 
soluble  in  cold  water,  and  with  a  strongly  alkal- 
ine reaction. 

3.  Crusocreatinine,  Ce  Hs  N*  O. — Possessing  the 


LEUCOMAINES.  293 

general  properties  of  Kreatinine  which  it  strongly 
resembles  in  chemical  elements  and  alkalinity. 

4.  Amphicreatinine,  Ca  Hia  Nt  O4. — Corresponds 
with  two  molecules  of  Kreatme  plus  the  C  N  H 
groupment,  thus  having  the  closest  analogy  to 
Kreatine,  although  the  formula  seems  to  differ 
widely  from  it. 

"  III.  An  unclassified  Group — According 
TO  THEIR  Sources. 

1.  From  the  urine. — A  uride — allantoine — and  a 
base — Karnine — already  known,  a  second  alka- 
loid has  been  discovered  with  the  formula  Ct  H14 
N4  O.. 

2.  From  the  blood  and  important  viscera. — Alka- 
loids have  been  met  with  in  appreciable  quanti- 
ties. 

3.  Fro7n  the  spleen. — Mr.  Morel,  of  Lille,  has  ob- 
tained an  alkaloid  isolated  in  deliquescent  crys- 
tals. 

4.  From  the  intestines. — A  base  which  seems  to 
belong  to  the  pyridic  group  isolated  from 
choleraic  dejections. 

5.  From  the  saliva. — Gautier  has  determined 
the  existence  of  an  alkaloid  in  human  saliva. 

6.  From  the  venoms  of  certain  snakes  and  batra- 
chians  as   well   as   certain   mollusca  and  fishes. — 


294  LEUCOMAINES  AND    EXTRACTIVES. 

From  this  latter  class,  Brieger  has  identified  an 
active  principle  in  the  mytiloxin  and  has  given  its 
formula  as  C«  His  N  O2." 

The  ^^  Extractives^ — It  has  been  ascertained, 
that  the  ptomaines  and  leucomaines  are  accom- 
panied by  equally  nitrogenous  but  not  alkaloidic 
substances  the  exact  nature  of  v^hich  is  not  yet 
know^n.  But  the  fact  has  been  verified  that  they 
are  endowed  with  greater  toxic  properties  than 
the  ptomaines  and  leucomaines.  They  are  called 
the  extractives  for  convenience  of  distinction. 
Not  being  well  known,  they  cannot  yet  be  prop- 
erly named. 

'*  According  to  the  different  sources  of  poison- 
ing ;    there  are  different  indications,  signs, 

or  symptoms,  capable  of  classification  as  below : 
(i,)  Poisoning  by  the  '  extractives  *  is  attended  by 
hyperthermia.  (2,)  Poisoning  by  the  '  animal 
alkaloids'  is  accompanied  by  hypothermia.  (3,) 
A  combination  or  succession  of  hyperthermic  and 
hypothermic  phenomena  may  become  manifest, 
according  to  the  combination  or  alternation  of 
poisoning  by  the  deleterious  physiological  pro- 
ducts, or  their  antagonistic  action."  (Brown, 
quoted  from  Aitken). 

The  body  of  man  in  health  may  become  pois- 
oned by  the  gradual  accumulation,  within  itself, 
of  deleterious  substances  normally  elaborated  but 


LEUCOMAINES  AND   EXTRACTIVES.  295 

imperfectly  eliminated.  Hence  the  slow  and  in- 
sidious onset  of  much  ill  health,  from  which  re- 
covery is  correspondingly  slow.  Constitutional 
diseases  such  as  gout  and  rheumatism  being 
examples  of  the  effects  of  this  auto-infection. 
(Aitken).  How  this  auto-infection  takes  place 
Doctor  Brown  says,  can  only  be  understood  and 
explained  by  the  mode  in  which  the  phenomena 
of  life  are  regarded.  **  Life  is  the  result  of  the 
combination  of  many  physiological  processes,  in 
the  concurrent  exercise  of  the  bodily  functions 
which  are  essentially  relative  and  contingent  on 
each  other,  implying  at  the  same  time  a  series  of 
partial  and  local  deaths.  Thus  it  is  that  the 
organism  lives  on  conditions  of  incessant  elemen- 
tary disintegrations." 

Man  resists  the  auto-infection  to  which  he  is 
constantly  exposed;  ''(i,)  by  the  elimination 
through  the  liver,  the  kidneys,  the  skin,  the 
lungs,  and  the  intestinal  mucous  membrane  ;  (2,) 
by  the  destruction  of  the  toxic  products  by  oxy- 
genation, which  consists  in  a  continuous  combus- 
tion of  the  leucomaines  by  the  oxygen  of  the 
blood,  in  which  they  are  consumed,  or  partially 
in  the  tissues  and  organs." 

The  foregoing  summary  of  the  present  state  of 
knowledge  of  the  ptomaines,  leucomaines  and 
"  extractives,"   is   abstracted  from  the  works  of 


296  GENESIS   OF   INFECTIOUS  DISEASES. 

Hallopeau,  *  Cornil  and  Babes,  f  Gautier,  J 
Brieger,  ||  Brunton,  |||  Brown,  §  Aitken,  §§  and 
from  the  Chemical  News.  T[ 

The  fact  that  the  genesis  of  infectious  diseases 
is  bacteria  or  at  least  ptomainic,  is  accepted  by 
many  experienced  pathoanatomists  and  practising 
physicians,  and  also  by  surgeons,  particularly  in 
the  case  of  septicaemia  occurring  after  severe  in- 
juries or  after  surgical  operations. 

The  study  of  the  clinical  aspects  of  the 
ptomaines,  leucomaincs,  and  "  extractives,"  so 
well  begun  by  Doctor  Lauder  Brunton  and  Sir 
William  Aitken  of  London,  by  Professor  Peter  of 
Paris,   and   by  other  clinicians,  will  surely  lead 


*  Traite  Elementaire  de  Pathologic  Generale.     Paris  1887. 

t  Les  Bacteries,  etc.     Paris  1886. 

\  Sur  les  alcaloides  derives  de  la  destruction  bacterienne  ou 
physiologique  des  tissues  animaux.  Bulletin  de  V Academie 
de  Medecine.     Paris  1886. 

II  Microbes  Ptomaines  et  Maladies.  Ouvrage  traduit  de 
TAllemand  par  le  Dr.  Roussy  et  J.  Winter.     Paris  1887. 

III  On  disorders  of  digestion,  their  consequences  and  treat- 
ment.    London   1886. 

§  A  Treatise  on  the  Animal  Alkaloids,  Cadaveric  and  Vital ; 
or  the  Ptomaines  and  Leucomaines.     London  1887. 

§§  On  the  Animal  Alkaloids,  etc.  American  edition.  Phila- 
delphia 1887. 

t  The  "Chemical  News,"  1886-7. 


PYOSAPRAEMIA,   BACTERIA.  29/ 

many  physicians  earnestly  to  consider  this  very 
important  subject. 

For  convenience  and  a  clearer  understanding- 
of  the  subject  it  would  be  well  for  a  number,  if 
not  all,  of  the  bio-chemists,  who  are  engaged  in 
the  investigation  of  the  ptomaines,  leucomaines 
and  "extractives,"  to  have  a  conference  for  the 
purpose  of  constructing  a  uniform  nomenclature 
and  classification  of  these  toxic  agents. 

34.  Pyosapraemia*  signifies  putrid-pus  infec- 
tion of  the  blood.  The  term  pyaemia  is  ordina- 
rily employed  to  designate  the  condition  above 
named,  because  it  was  originally  believed  that 
pus  cells  effected  an  entrance  into  the  circulation. 
It  is  now  known  that  the  pus  of  a  wound  does 
not  pass  into  the  blood  current,  but  that  the  ele- 
ments of  putrid-pus  make  their  way  mto  the 
blood.  Therefore  the  term  pyosapraemia  is  the 
more  exact. 

Pyosapraemia  differs  from  septicaemia  both 
clinically  and  pathically.  Septicaemia  often  oc. 
curs  before  the  formation  of  pus,  and  the  blood  is 
poisoned  in  the  manner  already  stated,  while 
pyosapraemia  may  not  show  itself  until  several 
weeks  after  the  infliction  of  a  wound.  In  sep- 
ticaemia there  are  generally  no  secondary  ab- 


*  From  levo?,  pus,  6a7tpoi,  putrid,  and  atpiocj  blood. 


298  BACTERIA. 

scesses.  In  pyosapraemia  infective  thrombi, 
swarming  with  microorganisms,  are  formed  in 
the  veins  and  carried  into  circulation  to  cause 
multiple  abscesses  in  the  viscera  and  other  parts 
of  the  body  distant  from  the  spot  injured.  In 
these  thrombi,  the  staphylococcus  and  streptococcus 
Pyogenes  are  found. 

A  word  concerning  bacteria  in  general  may  not 
here  be  out  of  place,  for  their  importance  in 
medicine  and  surgery  is  undoubted  by  those  who 
have  critically  examined  the  whole  subject.  The 
great  question,  not  yet  solved,  is  to  what  extent 
the  bacteria  themselves  constitute  the  morbific 
cause,  and  to  what  extent  this  cause  is  to  be 
sought  in  the  infection  of  the  blood  by  the  alka- 
loids which  these  microorganisms  manufacture. 

Bacteria. — Towards  the  end  of  the  seventeenth 
century,  Leuwenhoek  discovered  the  leptothrix 
and  vibrio  in  the  saliva  and  faeces,  and  believed 
these  microorganisms  to  be  animalcules.  It  was 
not  until  1838  that  they  were  looked  upon  as 
bacteria.  In  his  thesis  for  the  doctorate  in  science 
(1853)  Ch.  Robin  classed  vibriones  and  bacteria 
with  algae  and  yeast  fungi.  It  is,  however,  only 
in  the  last  fifteen  or  twenty  years  that  bacteria 
have  been  largely  studied  in  their  relation  to  dis- 
ease. These  studies  were  not  instituted  until 
some  time  after  Davaine  and  Pasteur  had  demon- 


BACTERIA.  299 

strated  the  connection  of  bacteria  with  certain 
diseases  of  the  lower  animals,  notably  anthrax. 

The  microbia  are  so  largely  diffused  in  the  air, 
water  and  earth,  and  the  destructive  properties 
of  these  infinitely  small  organisms  are  so  great 
that  they  have  been  styled  the  masters  of  the 
world.  The  schizomycetes,  which  contribute 
most  of  the  pathogenic  species,  as  their  name  im- 
plies, are  multiplied  by  division  and  with  great 
rapidity.  They  are  parasitic,  living  upon  organ- 
ized substances  which  they  destroy  by  causing 
fermentation  and  putrefaction.  They  float  in  the 
air  mixed  with  dust,  are  found  in  stagnant  water, 
in  sewers,  in  sluggish  streams  flowing  through 
cities,  in  harbors,  on  the  sea  coast,  and  even  in 
the  depths  of  the  ocean  ;  in  fact  wherever  they 
find  sustenance.  They  occur  in  large  quantities 
in  the  mouth  and  in  the  fecal  matter  of  man  and 
beast.  In  the  soil  their  quantity  is  prodigious, 
particularly  in  damp  places,  or  during  rainy 
season.  Duclaux  has  shown  that  the  germination 
of  plants  cannot  take  place  in  a  soil  which  has 
been  deprived  of  microorganisms,  and  that  plants 
cannot  utilise  organic  substances  until  these  have 
been  modified  by  the  microbia. 

The  bacteria  infest  the  human  body  by  effect- 
ing entrance  principally  through  the  respiratory 
and  digestive  organs.  Cheese  and  fermented  milk 


300  BACTERIA. 

are  filled  with  microorganisms.  It  is  said  that 
the  gastric  juices  arrest  their  growth.  Pasteur 
and  Duclaux  are  of  opinion  that  digestion  cannot 
be  effected  without  their  intervention. 

The  schizomycetes  probably  appeared  among 
the  first  vegetables.  Van  Tieghem  has  found 
them  in  coal.  They  have  always  occured  in  the 
mouth  of  man.  Zopf  and  Miller  have  found  rods 
of  leptothrix  upon  the  teeth  of  Egyptian  mum- 
mies.    (Cornil  and  Babes.) 

Since  1870  Cohn  and  other  bacteriologists  have 
devoted  much  time  and  labor  to  the  study  and 
arrangement  of  pathogenic  microorganisms,  and 
Budd,  PoUender,  Naegeli,  Zopf,  Van  Tieghem, 
Koch,  Rabenhorst,  Fliigge,  Sternberg,  and  many 
others  have  contributed  valuable  material  in 
illustration  of  the  assertion  that  ''infectious  dis- 
eases are  due  to  a  living  contagion."  *  This 
statement,  respecting  infectious  diseases,  made, 
as  a  hypothesis,  many  years  ago,  by  Henle,  Sir 
Henry  Holland,  and  J.  K.  Mitchell,  of  Philadel- 


*  As  long-  ago  as  the  middle  of  the  eighteenth  century, 
Needham,  Buffon,  Spellanzani,  Bonnet,  and  others,  had 
demonstrated  the  existence  of  low  organisms  in  putrid  matter, 
but  without  clearly  understanding  their  nature,  although  they 
considered  these  organisms  as  factors  in  the  production  of 
disease. 


BACTERIA.  301 

phia,  is  now,  by  most  pathoanatomists,  considered 
as  demonstrated. 

Davaine  seems  to  have  been  the  first  to  estab- 
lish that  these  microorganisms  are  vegetable  and 
not,  as  originally  believed,  animal  parasites.  Cohn 
placed  them  in  the  class  of  Schizospores  (cleav- 
ing spores)  and  found  that  they  contained  no 
chlorophyll.  Naegli  named  them  Schizomycetes 
(cleaving  fungi),  and  Billroth  asserted  that  they 
consisted  of  only  one  species,  which  he  called 
coccobacteria  septica. 

Cohn  has  divided  morphically  the  schizomy- 
cetes into  four  groups  : 

1.  Sphero-bacteria,  or  globular  bacteria,  cocci \ 

2.  Microbacteria,  or  bacteria  in  rods,  short  rods; 

3.  Desmobacteria,  or  bacilli,  long  rods  ; 

4.  Spiro-bacteria,  or  spiral  bacteria,  spirilla. 

SYNOPSIS 

OF  corn's  classification  of  bacteria. 

Schizophytes. — Thallophytes  being  developed 
by  division  or  by  endogenous  germinative  cells. 

First  tribe. — A.  Free  cells  united  by  two  or  by 
four. 

Spherical  cells chroococcus  (Naegli). 

Cylindrical  cells . . .  ,synechococcus  (Naegli). 


302  BACTERIA. 

B.  Cells  united  in  zoogloeae  by  an  amorphous 

substance. 

a.  Cellular  membrane  confounded  with  the  in- 

tercellular substance. 
Sphericial  cells. . .  .micrococcus  (Hallier). 
Cylindrical  cells.  .  .bacterium  (Dujardin). 

b.  Intercellular  substance  arranged  in  concen- 

tric layers. 

Round  cells glaeocapsa. 

Cylindrical  cells glaeothece. 

C.  a.  Cells  forming  circumscribed  zoogloeae 

of   definite   form,    families   arranged   in 

plates  of  a  single  layer. . .  .merismopedia. 
Round    cells    arranged   in   a   network    of 

zoogloeae ....  clathrocystis. 
Cylindrical   and  cuneiform    cells,    families 

divided  by  constriction. .  .coelosphaerium. 
Cells  forming  families  with  several  layers 

united  in   cubical,   colorless  corpuscles, 

with  quarternary  arrangement . .  .sarcina. 
Very  great  but  undetermined  number  of 

colorless  cells ....  ascococcus. 

Second  tribe,  nematogenes. — Filamentous  cells. 

A.  Without  ramifications : 

I.  Cylindrical,  colorless,  with  little  marked 
division,  very  slender,  short,  bacillus  \ — long, 
leptothrix. 


BACTERIA.  303. 

2.  Cylindrical  filaments,  thicker  and  longer^ 
beggiatoa. 

3.  Broken,  with  colorless  conidia,  crenothrix. 

4.  Spiral,  short,  and  undulated  filaments,  vi- 
briones  ; — short,  with  rigid  spirals,  spirillum  ; — 
long,  with  flexible  spirals,  containing  phyco- 
chrome,  spirocyth ; — long  filaments  and  flexible 
spirals,  spirulina. 

5.  Filaments  in  beads  without  phycochrome, 
streptococcus. 

6.  Cylindrical  and  colorless  zoogloeae,  myconos^ 
toe ; — in  beads,  nostoc  ; — filaments  thinned  at  one 
extremity,  rivolaria. 

B.  Filaments  with  false  ramifications,  clado^ 
thrix ; — cylindrical  and  colorless  fila- 
ments, streptothrix, 

synopsis  of 

zopf's  pleomorphic  classification  of 

the  schizomycetes  * 

Zopf  divides  the  schizomycetes  (fission-fungi) 
into  four  groups  :  Coccaceae  ;  Bacteriaceae ; 
Leptotricheae  ;  Cladotricheae  ;  sixteen  genera : 
Streptococcus  ;  Merismopedia ;  Sarcina  ;    Micro- 


*  Taken  in  greater  part  from  Crookshank* 5  Manual  of 
Bacteriology,    Second  edition,  1887. 


304  BACTERIA. 

coccus;  Ascococcus; — Bacterium;  Spirillum; 
Leuconstoc  ;  Bacillus  ;  \ribrio  ;  Clostridium  ; — 
Crenothrix  ;  Beggiatoa  ;  Phragmidiothrix  ;  Lep- 
tothrix,  Cladothrix ; — and  one  hundred  and 
ninety-five  species. 

Group  I.    Coccaceae. 

Possessing,  so  far  as  known,  only  cocci,  and 
thread  forms  resulting  from  the  juxtaposition  of 
cocci.  The  fission  occurring  in  one  or  several 
directions. 

Genera:  i,  Streptococcus  \  2,  Micrococcus  \  3, 
Merisinopedia\     4y  Sarcina-,     ^^  Ascococcus, 

Genus  L     Streptococcus  (chain  cocci). 

Divide  in  only  one  direction.  The  cocci  are 
generally  united  in  the  form  of  chains. 

Species. 

Species  associated  with  disease  in  man  and 
animals. 

1.  Streptococcus  pyogenes.  .Pathogenic  in  man 

and  animals. 

2.  "  **   malignus.  .Saprophytic in 

man,  patho- 
genic in  ani- 
mals. 


BACTERIA.  305 

3.  Streptococcus  pygenes  aureus Pathogenic 

in  man  and 
animals. 

4.  "  "   albus Pathogenic  in 

man  and  ani- 
mals. 

5.  "  "   citreus  ....  Pathogenic  in 

man  and  ani- 
mals. 

6.  *'  cereus  albus . .  Associated   with   pus, 

but  not  pathogenic 
in  man  or  animals. 

7.  "  cereus  flavus.  .Associated   with  pus, 

but  not  pathogenic 
in  man  or  animals. 

S.  "  erysipelatosus.. Pathogenic    in    man 

and  animals. 

9.  '*  toxicatus Pathogenic  (?) 

10.  "  in  puerperal  fever.  .Possibly     sapro- 

phytic only. 

11.  "  in  endocarditis Possibly    sapro- 

phytic only. 

12.  "  in  diphtheria Possibly    sapro- 

phytic only. 

13.  "  articulorum ..  Saprophytic    in    man, 

pathogenic     in     ani- 
mals. 


306  BACTERIA. 

14.  Streptococcus  in  cerebro-spinal  meningitis. . . 

Possibly  saprophytic  only. 

15.  "  in  yellow-fever.  .Possibly    saprophy- 

tic only. 

16.  "  in  dental  caries.  .Possibly  saprophy- 

tic only. 

17.  "  variolae  etvacciniae.  .Pathogenic  in 

man    (?)    and 
animals  (?). 

Species  associated  with  disease  in  animals. 

18.  Streptococcus    of    swine-erysipelas ...  Patho- 

genic (?). 

19.  "  of  cattle  plague Pathogenic. 

20.  "  of  foot  and  mouth  disease  " 

21.  "  of   septicaemia   consecu- 

tive to  anthrax " 

22.  "  septicus ** 

23.  '*  of  progressive  tissue  ne- 

crosis in  mice " 

24.  *  "  perniciosus Pathogenic  (?). 

25.  "  bombycis Pathogenic. 

26.  "  insectorum Possibly  saprophytic 

only. 

Species  unassociated  with  disease. 

27.  Streptococcus  viscosus. . .  .Zymogenic  sapro- 

phyte. 


BACTERIA.  307 

28.  Streptococcus  coronatus . .  Simple  saprophyte. 

29.  "  radiatus **  " 

30.  **  flavus  desidens. .       "  ** 

Genus  II.     Merismopedia^  (Plate-cocci). 

Divide  in  two  directions,  forming  lamellae  or 
plates. 

Species. 
Species  associated  with  disease. 

1.  Merismopedia gonorrhoeae. Pathogenic  in  man, 

2.  Micrococcus  tetragonus.  .Saprophytic  in  man, 

pathogenic  in  ani- 
mals. 

3.  Diplococcus  albicans  tardissimus.. Saprophytic 

in  man. 

Species  unassociated  with  disease. 

4.  Micrococcus    citreus    conglomeratus.  .Simple 

saprophyte- 

5.  "  subflavus Simple  saprophyte. 

6.  "  albicans  amplus. ..       "  ** 

Genus  III.     Sarcina,  (Packet-cocci). 
Divide  in  three  directions,  forming  colonies  in 
cubes  or  packets. 

Species, 

Unassociated  with  disease. 

I.  Sarcina  lutea Chromogenic  saprophytes. 


3o8 


BACTERIA. 


Sarcina  aurantiaca.Chromogenic  saprophytes. 

"        ventriculi Simple  saprophytes. 

"        intestinalis 

"        urinae 

"        litoralis 

"        Ritenbachii 

"        hyalina 

alba 


Genus  IV.     Micrococais^  (Mass-cocci). 

Divide  in  one  direction,  after  division  the  cocci 
may  remain  aggregated  in  irregular  heaps,  but 
never  form  chains. 

Species. 

Species  associated  with  disease  in  man. 

I.  Micrococcus  in  scarlatina Possibly  only 

saprophytic, 
in  measles. . . .  Possibly  only  saprophytic, 
in  whooping 


2. 
3. 


4- 

5. 
6. 


cough 
in  haemophilia 
neonatorum 

in  typhus 

in  acute  yellow 
atrophy 
in  dental  caries 
in  gangrene . . . 


<( 


BACTERIA.  309 

9.  Micrococcus  pyogenes  tenuis.  .Possibly  only 

saprophytic. 
la       "  in  rabies Pathogenic  (?). 

In  animals. 

11.  "  of  septicaemia  in  rabbits Pathogenic. 

12.  "  of  pyaemia        "         '*       " 

13.  "  of  progressive  suppuration  in 

rabbits " 

14.  "  parvus  ovatus ** 

15.  "  of  pyaemia  in  mice " 

In  plants. 

16.  Micrococcus  amylivorus Pathogenic  (?)► 

Species  unassociated  with  disease. 

17.  Micrococcus  cyaneus.. .  .Chromogenic  sapro- 

phyte. 

18.  "  aurantiacus. Chromogenic  saprophyte^ 

19.  "  chlorinus. ..  "  «« 

20.  *'  violaceus. ..  "  " 

21.  "  luteus **  " 

22.  "  rosaceus  ...  **  " 

23.  "  haematodes  "  " 

24.  "  candidus Simple  saprophyte. 

25.  **  candicans '*  ** 

26.  "  foetidus 

27.  **  crepusculum "  " 

28.  "  cinnabareus "  " 


310  BACTERIA. 

29.  Micrococcus  flavus  lique- 

faciens ....  Simple  saprophyte. 

30.  "       '*       tardigradus 

31.  "  versicolor 

32.  "  viticulosus 

33.  "  lacteus  faviformis. 

34.  "  fulvus 

Genus  V.     Ascococcus,  (Pellicle-cocci). 

Are  like  the  micrococci,  but  the  cocci  grow  in 
characteristic  gelatinous  pellicles. 

Species. 

Unassociated  with  disease. 

I.  Ascococcus  Billrothii. Zymogenic  saprophyte. 

Group  II.    Bacteriaceae. 

*"  Possessing  mostly  cocci,  rods  (straight  or  bent), 
and  thread  forms  (straight  or  spiral).  The  first 
may  be  absent,  and  the  last  possess  no  distinc- 
tion between  base  and  apex.  Division,  as  far  as 
known,  occurs  in  one  direction. 

Genera:     i,  Bacterium]  2 y  Spirillum;    3,  Vibrio; 
4,  Leuconstoc]  5,  Bacillus',  6,  Clostridium. 

Genus  I.     Bacterium. 
Cocci  and  rods,  or  only  rods,  which  are  joined 


BACTERIA.  311 

to  form  threads.     Spore-formation  absent  or  un- 
known. 

Species. 

Species  associated  with  disease  in  man  and 
animals. 

1.  Bacterium  pneumoniae  crouposae. ...  Patho- 

genic (?);  possibly 
only  saprophytic 
in  man,  patho- 
genic in  animals. 

2.  "  pseudo — pneumonicum.. Saprophytic  in 

man,  patho- 
genic in  ani- 
mals. 

3.  "  Neapolitanum Saprophytic  in  man, 

pathogenic  in  ani- 
mals. 
14.         "in  rhinoscleroma.  Pathogenic  in  man  (?). 

5.  "  in  diphtheria Saprophytic  in  man  (?), 

pathogenic     in     ani- 
mals. 

6.  "  saprogenes Saprophytic    in    man, 

pathogenic     in     ani- 
mals. 

7.  "  decalvans Saprophytic. 


312  BACTERIA. 

Species  associated  with  disease  in  animals. 

8.  Bacterium  in  diphtheria  of  calves Patho- 

genic (?). 

9.  "  in  diphtheria  of  pigeons. . . .  Pathogenic* 
ID.         **  cholerae  gallinarum 

11.  "  septicum  agrigenum 

12.  "  of  septicaemia  in  rabbits. . . . 

13.  *'  of  Davaine's  septicaemia. . . . 

14.  "  septicum  sputigenum 

15.  "  crassum  sputigenum 

16.  *'  pneumonicum  agile 

17.  *'  oxytocum  perniciosum 

18.  "  cavicida 

19.  "  coli  commune 

20.  *'  lactis  aerogenes 

21.  Panhistophyton  ovatum 

In  plants. 

22.  Bacterium  hyacinthi Pathogenic  (?). 

Species  unassociated  with  disease. 

23.  Bacterium  synxanthum.  .Chromogenic  sapro- 

phyte. 

24.  *'  indicum Chromogenic  saprophyte* 

25.  "  rubrum "  " 

26.  "  prodigiosum..  "  " 

27.  "  luteum "  " 

28.  '*  violaceum ...  "  " 


it  l« 


((  11 


BACTERIA,  313 

29.  Bacterium  brun- 

neum..Chromogenic  saprophyte. 

30.  *'  fluorescens 

putidum 

31.  "  fluorescens 

liquefaciens 

32.  "  ureae Zymogenic  saprophyte. 

33.  *'  aceti "  •' 

34.  "  Pasteurianum. .  "  ** 

35.  "  liodermos Simple         " 

36.  *'  multipediculum  ....       **  " 

37.  "  ramosum  lique- 

faciens.      "  " 

38.  "  Zopfii 

39.  **  merismopedioides  . . 

40.  "  Fflugeri 

41.  "  photometricum " 

42.  *•  litoreum ** 

43.  "  fusiforme "  " 

44.  **  navicula "  " 

45.  Proteus  vulgaris 

46.  "         mirabilis 

47.  '*        Zenkeri *• 

48.  Bacterium  termo 

49.  *'         lineola ** 


it 
ft 
« 


n  n 

((  tt 

It 


Genus  II.  Spirillum. 
Threads  screw-form,  made  up  of  short  or  long 


314  BACTERIA. 

rods  only,  or  of  rods  and  cocci.    Spore-formation 
absent  or  unknown. 

Species. 

Species  associated  with  disease  in  man  and 
animals. 

1.  Spirillum  Obermeieri Pathogenic. 

2.  **  cholerae  Asiaticae. Pathogenic  in  man  (?), 

possibly  only  sapro- 
phytic. Pathogenic 
in  animals. 

3.  "  Finkleri.. .  .Saprophytic  in  man.  Patho- 

genic in  animals. 

4.  "  tyrogenum .  Saprophytic.  Pathogenic  in 

animals. 

5.  "  sputigenum. Saprophytic.  Pathogenic  in 

animals. 

Species  unassociated  with  disease. 

6.  Spirillum  plicatile Simple  saprophyte. 

7.  "  serpens 

8.  "  tenue 

9.  "  undula 

10.  *'  volutans   

11.  "  Rosenbergii 

12.  '*  attenuatum    

13.  "  leucomelaneum. .. 


BACTERIA.  315 

Genus  III.     Leuconstoc. 

Cocci  and  rods.  Spore-formation  present  in 

cocci. 

Species. 
Unassociated  with  disease. 
I.  Leuconstoc  mesenteroides Zymogenic  sa- 
prophyte. 

Genus  IV.     Bacillus. 

Cocci  and  rods,  or  rods  only,  forming  straight 
or  twisted  threads.  Spore-formation  present 
either  in  rods  or  cocci. 

Species. 

Species  associated  with  disease  in  man  and 

animals. 

1.  Bacillus  leprae Pathogenic. 

2.  ^  "  in  syphilis Pathogenic  (?) ;  possibly 

only  saprophytic. 

3.  "  typhosus Pathogenic  (?) ;  possibly 

only  saprophytic. 

4.  "  malariae.  ..Pathogenic  in  man  (?),  patho- 

genic in  animals. 

5.  "  of  choleraic  diarrhoea  from 

meat  poisoning.  .Pathogenic. 

6.  "  pyogenes  foetidus.. Saprophytic  in  man, 

pathogenic  in  animals. 


3l6  BACTERIA. 

7.  Bacillus  in  septicaemia  in  man.  .Saprophytic. 

8.  "  in  gangrenous  septicaemia.  " 

9.  "  tuberculosis Pathogenic. 

10.  **  antracis " 

1 1.  "  mallei " 

12.  "  of  malignant  oedema  (ani- 

mals)          " 

13.  "  of  septicaemia  of  mice " 

14.  *'  of  ulcerative  stomatitis  in 

the  calf *' 

1 5.  *'  swine-typhoid " 

16.  "  swine-erysipelas ** 

17.  "  in  tetanus  (animals) Pathogenic  (?). 

18.  "  alvei  (animals) Pathogenic. 

Species  unassociated  with  disease. 

19.  Bacillus  ianthinus. .Chromogenic  saprophyte. 

20.  "  pyocyaneus  ..  "  '* 

21.  **  cyanogenus  ..  "  " 

22.  "  acidi  lactici Zymogenic 

23.  "  Fitzianus " 

24.  "  subtilis Simple 

25.  **  figurans ** 

26.  *'  of  jequirity 

27.  "  caucasicus 

28.  "  dysodes   

29.  "  Hansenii " 

30.  "  erythrosporus " 


It 
ti 
t( 

tt  <i 

tt  u 

It  tt 

tt 
tt 


BACTERIA. 


317 


31.  Bacillus  septicus Simple  saprophyte. 


32. 
33- 
34- 
35. 
36. 
37. 
38. 


'  saprogenes 

'  foetidus 

*  putrificus  coli 

'  coprogenus  foetidus. 

*  aerophilus 

*  mesentericus  fuscus. 

*  "  vulgatus 


it 
If 
« 
II 
If 
II 


Genus  V.     Vibrio. 

Threads   screw-form   in   long   or   short    links. 
Spore-formation  present. 

Species. 

Unassociated  with  disease. 

I.  Vibrio  rugula Zymogenic  saprophyte. 

Genus  VI.     Clostridium. 

Same  as  bacillus,  but  the  spore-formation  is  in 
characteristically  enlarged  rods. 

Species. 
Associated  with  disease  in  animals. 

1.  Clostridium  of  symptomatic  anthrax. .  .Patho- 

genic. 

Unassociated  with  disease. 

2.  Clostridium  butyricum. Zymogenic  saprophyte. 

3.  "  polymyxa.         **  " 


3l8  BACTERIA. 

Group  III.    Leptotricheae. 

Possessing  cocci,  rods,  and  thread  fornns  (which 
show  a  distinction  between  base  and  apex).  The 
last  straight  or  spiral. 

Genera :  i,  Crenothrix  ;  2,  Beggiatoa  ;  3,  Phrag- 
midiothrix ;  4,  Lepothrix. 

Genus  I.     Crenothrix. 

Threads  articulated ;  cells  sulphurless;  habitat 
water. 

Species, 

Unassociated  with  disease. 
I.  Crenothrix  Kiihniana Simple  saprophyte. 

Genus  11.     Beggiatoa. 
Threads    unarticulated ;     cells    with    sulphur 
granules ;  habitat  water. 

Species. 
Unassociated  with  disease. 

1.  Beggiatoa  alba Simple  saprophyte. 

2.  "  mirabilis '*  ** 

3.  *'  roseopersicina.  .Chromogenic     ** 

Genus  III.     Pkragmidiothrix. 

Threads  jointless ;  successive  subdivision  of  the 
cells  is  continuous ;  cells  sulphurless ;  habitat 
water. 


BACTERIA.  319 

Species, 
Unassociated  with  disease. 
I,  Phragmidiothrix  multiseptata. .  .Simple  sapro- 
phyte. 

Genus  IV.     Leptothrix. 
Threads  articulated  or  unarticulated ;  succes- 
sive subdivisions   of   cells   not  continuous;  cells 
sulphurless. 

Species. 
Associated  with  disease. 

1.  Leptothrix  buccalis Saprophytic. 

2.  "  gigantea " 

Group  IV.    Cladotricheae. 

Possessing   cocci,    rods,   threads,   and   spirals. 
Thread-forms  provided  with  false  branchings. 
Genus,  Cladothrix. 

Genus  I.     Cladothrix. 

Species. 

Unassociated  with  disease. 

1.  Cladothrix  dichotoma Saprophyte. 

2.  "         Foersteri " 

Associated  with  disease. 

3.  Actinomyces Pathogenic. 


320  BACTERIA. 

This  classfication  although  very  defective  is  the 
most  easily  followed  and  seems  to  give  a  clearer 
view  of  existing  knowlege  of  schizomycetes  than 
any  of  the  others. 

FlUgge  divides  the  bacteria  into  four  classes: 

1.  Fungi 

2.  Mycetozoa 

3.  Blastomycetes 

4.  Schizomycetes. 

Most  of  the  pathogenic  organisms  belonging  to 
the  fourth  class,  he  reckons  the  following  as 
members  of  this  class : 

1.  Micrococcus  8.  Beggiatoa 

2.  Ascococcus  9.  Spirillum 

3.  Sarcina  10.  Spirochaete 

4.  Clathrocystis  11.  Streptothrix 

5.  Bacterium  12.  Cladothrix 

6.  Bacillus  13.  Myconstoc. 

7.  Leptothrix 

Of  doubtful  relation  to  the  schizomycetes  are 
the  crusothrix,  sphaerotilus,  spiromonas,  rhab- 
domonas,  Monas  Okeini,  and  Warmingii  vinosa. 
(Communicated  by  Doctor  Biggs). 

The  arrangement  of  Fliigge,  being  the  same  as 
that  of  Rabenhorst,  is  one  of  the  most  recent  and 
is  considered  as  the  best  by  many  histologists. 

The  "  classifications  of  bacteria  "  are  as  vary 


BACTERIA.  321 

ing  and  unsatisfactory  as  they  are  numerous.  A 
short  time  ago  the  suggestion  was  made,  to  a  dis- 
tinguished bacteriologist,  that  it  would  be  very 
desirable  to  establish  a  uniform  nomenclature 
and  classification  of  microbia.  He  replied  that 
the  time  had  not  yet  come  for  this,  because 
knowledge  on  the  subject  of  bacteria  is  insuf- 
ficient to  permit  of  such  classification. 

A  similar  reply  has  often  been  made  in  connec- 
tion with  the  classification  of  diseases.  The 
proper  time,  however,  to  begin  to  classify  is  al- 
ways the  present,  for,  it  should  be  remembered 
that  to  think  is  to  classify.  But  to  classify  well 
requires  of  the  thinker  that  he  shall  think  well ; 
and  well  directed  thoughts  are  likely  to  lead  to 
great  advances. 

If  the  bacteriologists  should  decide  to  work  in 
unison  and  in  harmony  with  the  single  purpose 
of  advancing  science,  setting  aside  all  personality, 
the  first  and  wisest  step  to  take  would  be,  after 
having  agreed  upon  a  proper  basis  and  method 
of  nomenclature  and  classification,  to  describe 
fully  and  accurately  the  known  bacteria,  then 
carefully  analyze  the  descriptions,  and  deduce 
therefrom  the  definitions  which  will  almost  in- 
variabl}''  furnish  correct  names.  Thus  they  would 
establish  a  uniform  and  true  classification  which 
would  be  understood  by  the  whole  profession. 


322  BACTERIA. 

The  outcome  of  the  needed  investigations 
would  be  the  proper  construction  of  the  genera, 
the  gathering  together  of  the  species,  the  relega- 
tion to  the  lower  rank  of  varieties,  of  many  that 
now  stand  as  species,  and  the  discovery  of  new 
species.  Much  greater  advances  would  thus  be 
made  than  by  waiting  indefinitely  for  **  the 
proper  time  to  come."  Then  the  clinicians  would 
be  able  to  use  to  advantage  the  knowledge  at- 
tained of  the  nature  and  pathic  properties  of 
these  deadly  enemies  of  suffering  humanity. 

The  study  entailed  by  the  preparation  of  the 
summary  of  the  present  state  of  knowledge  of 
the  bacteria,  ptomaines,  leucomaines  and  ''ex- 
tractives," has  led  to  the  following  conclusions : 

1.  That  pathohistology  needs  to  be  recon- 
structed on  the  basis  of  bio-chemistry. 

2.  That  hygiene  should  be  given  a  position  of 
much  greater  importance  that  it  has  ever  oc- 
cupied. 

3.  That  prophylaxy  should  be  placed  on  a 
firmer  footing  than  heretofore. 

4.  That  the  State  should  come  in  aid  with 
money  and  laws,  to  further  the  views  of  the 
medical  profession  in  the  means  proposed  for 
preventing  disease  and  hindering  epidemics. 

5.  That  therapy  should  be  subjected  to  many 


DISTURBANCES   IN  THE  CIRCULATION.       323 

modifications,  in  correspondence  with  the  great 
advances  in  pathohistology. 

6.  That  the  junior  student  (the  Doctor  of  the 
future)  should  devote  more  time  to  laboratory 
work,  and  to  experimental  medicine,  and  should 
be  more  thoroughly  trained  to  methods  of  pre- 
cision than  m  the  past. 

II.  Disturbances  in  the  Circulatory 
Apparatus. 

I.  Ischaemia,  from  t'dx^ty,  to  check,  to  restrain, 
and  at'jua,  blood,  signifies  arrest  of  blood,  and  is 
employed  only  in  the  sense  of  a  local  disturbance 
in  the  circulation.  It  arises  from  constriction  of 
the  capillaries  owing  to  disturbance  in  the  vaso- 
motor nerves.  The  plugging  of  an  arteriole  is 
also  a  factor  in  the  production  of  ischaemia.  It 
is  too,  the  effect  of  frost-bite  of  the  tips  of  the 
toes,  fingers,  ears  or  nose.  The  result  of  ischaemia 
is  local  capillary  anaemia  which  may  be  followed 
by  colliquative  necrosis  in  certain  tissues,  and  in 
others  by  moist  or  by  dry  gangrene. 

If  there  should  not  be  sufficient  constriction  of 
the  capillaries  to  arrest  the  circulation  in  a  given 
part,  but  enough  to  interfere  with  nutrition,  the 
condition  would  be  one  of  local  capillary  /lyjfo- 
aeinia. 


324      DISTURBANCES  IN  THE  CIRCULATION. 

The  term  ischaemia  has  been  improperly  used 
to  designate  "  local  arterial  anaemia,"  and  also 
the  '*  retention  or  suppression  of  an  habitual  flux 
of  blood  as  of  the  haemorrhoidal,  menstrual,  flux, 
or  of  epistaxis." 

2.  Athroisaemia, — from  aBpotdna,  accumulation, 
and  ai'jAa,  blood, — signifies  blood  accumulation, 
congestion.  It  is  a  more  exact  term  than  conges- 
tion which  is  applied  alike  to  the  accumulation  of 
any  other  fluid.  The  French  employ  the  term 
engorgement  to  designate  the  state  of  a  part 
gorged  with  blood  or  some  other  fluid.  The 
words  synathroismus,  haemostasia  and  many 
others  have  been  suggested  to  take  the  place  of 
consrestion.  But  some  of  them  are  used  in  dif- 
ferent  senses,  as  for  instance  haemostasia  which^ 
besides  signifying  stagnation  of  blood,  is  made  to 
do  duty  in  designatmg  a  means  to  arrest  haemor- 
rhage ;  haemostatic  being  derived  therefrom. 

"  Congestion, — from  conger Oy  I  heap  up, — is  de- 
fined as  the  accumulation  of  blood  in  the  blood 
vessels  of  an  organ." 

*•  Active  congestion  expresses  the  condition  of 
overfulness  of  blood  vessels  arising  from  paralj^sis 
of  the  vaso  motor  and  increased  energy  of  the 
vaso-dilator  nerves,  such  as  occurs  in  the  surface 
redness  of  active  exercise,  or  in  the  early  stage  of 
inflammation."     **  Passive  congestion — from  pass- 


DISTURBANCES   IN  THE   CIRCULATION.       325 

tvus,  suffering, — is  an  overplus  of  blood  in  the 
capillary  vessels  of  a  part,  associated  with  impair- 
ment of  the  vital  relations  between  the  blood  and 
the  minute  elements  of  the  texture,  as  the  cause 
of  the  sluggish  flow  of  blood  in  the  capillaries." 
(Aitken.) 

These  descriptions  are  good  and  clear,  but 
there  is  no  S3dlable  in  the  word  congestion  to  in- 
dicate that  it  is  the  blood  which  is  heaped  up. 

3.  Phlegmasia;  inflammation.     (See  p.  52.) 

4.  Lymphexosmosis  signifies  a  transudation 
from  lymph-vessels. 

5.  Lymphorrhagia  signifies  a  flow  from  a  rent 
l3Mnph-vessel.  Rhagia  has  been  wrongly  applied 
exclusively  to  flow  of  blood.  It  simply  means  a 
breaking  forth,  and  may  therefore  be  used  as  a 
terminal  to  lympho  as  well  as  to  haemo. 

6.  Haemorrhagia  signifies  a  flow  from  a  rent  or 
cut  blood  vessel. 

7.  Haemodiapedisis  signifies  an  oozing  of  blood 
through  the  walls  of  vessels.  This  is  commonly 
but  wrongly  confounded  with  haemorrhage 
which  always  implies  a  solution  of  continuity. 

8.  Thrombosis, — from  ^pon§o<iy  a  clot,  and  gdou, 
— signifies  coagulation.  The  coagulation  may 
take  place  in  a  blood  vessel,   or  in  the   heart ; 


326      ALTERATIONS  OF  STRUCTURE. 

hence  angiohaemothrombus,  cardiohaemothrom- 
bus. 

9.  Embolismus,  from  e^fioXo^,  a  plug — signifies 
simply  plugging.  An  angioembolus  is  a  vessel- 
plug. 

III.  Pathengenetic  Alterations  of 
Structure. 

The  terms  pathogenetic  and  pathengenetic 
should  not  be  confounded.  Pathogenetic  is  an 
adjective  signifying  that  which  generates,  disease 
generating,  while  pathengenetic, — from  Eyyevrji, 
sprung  from, — signifies  that  which  is  generated, 
engendered  by  disease.  In  other  words  a  pathen- 
genetic affection  is  a  disease  which  has  sprung 
from,  or  has  been  engendered  by  a  preexistmg 
disease.  This  word  was  suggested  by  Doctor 
Alfred  L.  Carroll.     (See  p.  56.) 

1.  Hypertrophy, — from  vTtEpy  over,  above, — 
signifies  over  nourishment,  and  is  here  used  in  its 
true  meaning  of  increased  nutrition  and  not  in- 
creased bulk.     (See  pp.  53-55.) 

2.  Hypotrophy,  —  iVo,  u:ider,  —  signifies  de- 
creased nutrition,  and  is  here  employed  in  its 
strict  sense  of  diminished  nutrition.  (See  pp. 
.53-55.) 

3.  Auxesis  is  used  in  the  sense  of  enlargement, 


RETROGRADE   METAMORPHOSES.  327 

increase,    and    is    substituted    for   hypertrophy. 
(See  pp,  52-55O 

4.  Ectasis  signifies  dilatation,  expansion.     (See 

P-  S7-) 

5.  Stenosis  signifies  contraction,  stricture.  (See 

p.  56.) 

6.  Ecmasis  signifies  obstacle,  obstruction.   (See 
P-  57.) 

IV.  Retrograde  Metamorphoses. 

1.  Necrosis,  — from  vexpoco,  I  kill, — signifies 
death.  As  it  is  here  used,  death  of  a  part.  The 
following  are  the  principal  necrotic  processes 
named  by  the  pathoanatomists:  Coagulation, 
colliquative  and  cheesy  necrosis,  ulceration,  and 
humid  and  dry  gangrene. 

2.  Meiosis, — from  ^Eioo/xaj  decrease, — signifies 
a  decrease  in  the  size  of  a  part  which  may  or  may 
not  shrivel.  Meiosis  is  here  employed  to  signify 
a  decrease  in  the  size  of  an  organ,  whatever  may 
be  the  cause  of  the  retrogression.  It  is  offered  as 
a  substitute  for  atrophy  which  should  be  used 
solely  to  signify  cessation  of  nutrition,  in  which 
sense  it  is  a  precursor  of  mortification.     (See  p. 

54.) 

3.  Degeneration  of  tissues  is  their  substitution 


328  NEOPLASMS. 

by  subordinate  elements,  such  as  granules  and 
fat,  and  amyloid,  colloid,  mucoid,  hyaline,  inoid, 
and  sclerous  substances. 

4.  Infiltration  of  tissues  is  the  permeation  of 
any  texture  by  a  fluid,  or  by  a  solid  substance  in 
suspension  or  in  solution.  Examples  :  fatty,  pig- 
mentary, calcareous,  uric,  infiltration. 

V.  Neoplasms. 

The  name  neoplasm  was  given  by  Burdach  to 
the  new  formations  whose  fundamental  tissue  he 
regarded  as  consisting  of  morbid  cellular  sub- 
stance. Virchow  adopted  the  term,  and  nearly 
all  pathoanatomists  have  since  done  so,  in  the 
sense  of  the  morbid  growths  arising  from  simple 
division  or  from  endogenous  multiplication  of 
preexisting  cells. 

It  has  been  questioned  if,  strictly,  there  can  be, 
in  the  human  body,  such  a  development  as  a  new- 
growth.  In  reality  the  growth  is  new  to  the 
particular  part  whence  it  springs,  though  it  may 
be  composed  of  the  same  tissues  that  exist  nor- 
mally in  this  part.  In  this  sense  it  may  be  said 
that  the  new-growth  must  be  composed  of  tissues 
lying  within  the  possibilities  of  the  individual. 
In  the  other  sense  it  must  be  entirely  foreign. 
The  examples  given  are  :  (i,)  a  growth  composed 


NEOPLASMS.  329 

of  feathers  would  be  a  new-growth  in  man  ;  (2,)  a 
growth  composed  of  hairs  would  be  a  new- 
growth  in  a  bird.  But  some  histologists  would 
say  there  are,  in  this  sense,  strictly  new-growths 
in  man,  e.  g.,  actinomycosis,  rhinoscleroma,  etc., 
which  are  not  even  composed  of  animal  sub- 
stances, but  of  vegetable  microorganisms. 

The  term  neoplasm  cannot  yet  be  rejected 
when  used  in  the  sense  of  a  growth  representing 
the  excessive  development  of  tissues  which  are 
identical  with  or,  at  least,  resemble  those  of  the 
normal  constituents  of  the  body.  **  Though  the 
cells  of  human  neoplasms  may  deviate  in  their 
appearance  from  the  cells  of  normal  tissues,  this 
deviation  is  not  so  extreme  that  their  analogues 
cannot  be  met  with  in  some  parts  of  the  normal 
body  during  intra  or  extra  uterine  life." 

It  may  be  of  interest  to  trace,  from  the  early 
writers,  the  history  of  the  development  of  the 
present  knowledge  of  neoplasms,  which  were 
called  tumors  and  are  still  so  named  by  many 
pathoanatomists.  Paul  Broca,  in  his,  "  Traite  des 
Tu7neurs''  (1866),  has  given  a  more  full  and  com- 
plete account  of  this  development  than  most 
other  authors.  The  following  is  therefore,  in 
part,  abstracted  from  his  classical  work. 

The  word  tumor,  which  Broca  uses  under  pro- 
test, signifies,  he  says,  in  its  most  general  accepta- 


330  NEOPLASMS. 

tion,  any  increase  of  volume,  abnormal  prom- 
inence, or  new  production,  apparent  or  con- 
cealed, internal  or  external. 

The  ancients,  and  their  followers  until  the  re- 
naissance, and  even  many  during  the  seventeenth 
and  eighteenth  centuries,  have  divided  the  tu- 
mors into  three  great  groups:  tumores  secundum 
naturam^  supra  naturam,  praeter  naturam.  These 
terms  were  accepted  by  all  but  with  no  consense 
as  to  the  exact  signification  which  they  should 
bear.  In  the  first  group  were  placed  the  im- 
pregnated uterus,  and  the  consequent  enlarge- 
ment of  the  mammae.  In  the  second  group  were 
included  those  tumors  arising  from  the  displace- 
ment of  natural  parts,  such  as  fractures,  and  dis- 
locations of  bones,  etc.  In  the  third  group  were 
the  tumors  that  arise,  not  from  the  natural  parts, 
but  from  the  development  of  new  tissues  or  the 
accumulation  of  the  humors.  This  last  group 
formed  one  of  the  grand  divisions  of  surgery.* 


*  The  surgical  Pentateuch  was  divided  into  five  books : 
{i,)  Wounds;  (2,)  Ulcers;  (3)  Fractures  ;  (4.)  Luxations  ; 
(5,)  Praelernatural  tumors.  The  fifth  book  constituting  more 
than  three-founhs  of  surgery.  In  it  were  placed,  dry  gan- 
grene, skin  diseases,  and  all  other  maladies  that  could  not 
enter  into  the  first  four  b^oks.  Galen  wrote  of  Tumores 
praeter  naturam,  and,  says  Broca,  this  Galenic  doctrine  is 
reproduced  in  several  of   his  other  works.     Tagault's,    In- 


NEOPLASMS.  331 

Thus  in  this  fourth  group  the  most  dissimilar 
diseases  were  placed  side  by  side,  simply  because, 
according  to  the  Galenic  doctrine,  they  were 
supposed  to  spring  from  the  same  causes.  All 
the  praeternatural  tumors  were  said  to  arise  from 
the  accumulation  of  one  of  the  humors  of  the 
economy,  hence  they  were  also  called  humoral 
tumors.  They  resulted  either  from  fluxion  or 
from  congestion. — Fluxion  occurred  when  a  nat- 
ural humor  was  attracted  to,  and  remained  in,  the 
affected  part,  and  congestion  when  the  humor 
was  engendered  in  loco.  The  humors  enumerated 
by  the  Galenists  were  four:  (i,)  the  blood  ;  (2,) 
the  bile  ;  (3,)  the  phlegm ;  (4,)  the  atrabile  or 
melancholy.  Giving  rise  to  phlegmons,  erysipe- 
las, oedema,  scirrhus.  Later  a  fifth  was  added, 
the  windy  humor,  which  produced  emphysema 
or  pneumatosis  (inflation).  Then  there  were 
mixed  tumors,  those  caused  by  two  or  several 
humors. 

stitutiones  Chirurgicae,  Paris  1543,  contains  a  book,  De 
iumoribiis  praeter  naturam.  This  author  appears  to  be  the 
first  to  give  an  analytical  classification  of  tumors  which  he 
groups  in  accordance  with  the  five  species  of  humors  ;  the 
fifth  species  being  the  windy  humor,  producing  infiationes. 
Broca  traces  down  to  Didier,  of  Montpellier,  171 1,  the  ancient 
arrangement  of  tumors  into  the  three  groups,  the  last  of  which 
being  tumores  praeter  naturam. 


332  NEOPLASMS. 

Humorism  was  succeeded  by  solidism,  and  this 
latter  doctrine,  in  its  turn,  was  overwhelmed  by 
the  advances  of  anatomy,  and  the  tumores  praeter 
naiuram  ceased  to  exist  after  phlegmons,  erysipe- 
las, oedema,  and  emphysema  were  removed  from 
the  group.  The  term  tumor  whose  nosographical 
acceptation  became  more  restricted,  was  finally 
reserved  to  designate  accidental  productions,  in 
the  organism,  characterized  by  the  formation  of 
new  tissue. 

The  Galenists  supposed  scirrhous  tumors  ta 
spring  from  the  accumulation  of  atrabile.  The 
innovators  of  the  seventeenth  century  failed  ta 
find  this  mythical  humor,  but  discovered  lymph 
which  served  to  establish  a  new  theory  of  tumors. 
It  is  plain  that  the  solidists  were  humorists  with- 
out being  aware  of  the  fact,  for  they  thought 
most  tumors  due  to  the  extravasation  of  lymph  ; 
that  their  various  forms,  and  their  various  term- 
inations, resulted  from  the  different  degrees  of 
crudity,  coction,  acidity,  alcalinity,  density^ 
acrimony,  depravation,  or  fermentation  of  this 
capricious  humor ;  and  that  these  phenomena 
varied  as  the  lymph  was  naturally  more  or  less 
thick,  or  stagnant,  and  that  the  affected  part  pos- 
sessed greater  or  less  heat. 

While  the  theory  of  the  day  ascribed  to  most 
tumors  a  common  cause,  the  practical  physicians 


NEOPLASMS.  333 

discovered  great  diversity  instead  of  the  pre- 
tended unity  of  cause.  Under  the  sway  of  the 
atrabile  theor}^  also  this  contradiction  had  become 
apparent,  and,  to  escape  from  the  dilemma,  the 
foundation  was  laid  of  a  doctrine  more  likely,  as 
it  was  thought,  to  be  adopted.  The  atrabile 
theory  was  so  vague  that  it  possessed  an  almost 
indefinite  elasticity  in  the  minds  of  its  promotors 
and  yielded  to  all  their  fancies.  Lymph,  on  the 
contrary,  had  a  real  existence,  had  been  seen  and 
analyzed,  and  though  the  characters  attributed 
to  it  were  far  from  being  exact,  they  were  form- 
ulated with  precision.  One  of  these  characters 
was  its  coagulability  by  heat,  and  the  appearance 
of  a  scum  at  the  surface  of  the  water  in  which 
tissues  impregnated  with  lymph  were  boiled. 
The  anatomical  study  of  tumors  consisted  in  boil- 
ing them,  and,  as  nearly  all  furnished  a  scum,  it 
was  concluded  that  they  were  of  lymphatic 
origin.  This  experiment  was  believed  to  estab- 
lish the  unity  of  cause  of  nearly  all  tumors. 
This  unity  of  cause  granted,  it  was  necessary 
to  explain  why  it  was  that  some  of  these  tumors 
were  benign  and  others  malignant.  The  promo- 
tors of  the  theory  then  had  recourse  to  the  hypo- 
thesis of  degeneration,  that  is  to  say,  the  trans- 
formation of  benign  into  malignant  tumors  by 
reason  of  the   depravation  of  the  lymph.     The 


334  NEOPLASMS. 

Galenists  had  already  offered  a  similar  explana- 
tion, for  they  regarded  cancer  as  inflamed  or 
degenerated  scirrhus.  But  the  adherents  of  the 
lymph  doctrine  applied  the  degeneration  hypo- 
thesis to  all,  even  to  scrophulous  and  lipomatous, 
tumors,  to  cysts  and  to  wens.  The  degeneration 
hypothesis  seems  to  have  been  a  compromise  be- 
tween the  lymph  theory,  and  clinical  observation 
which  proved  the  diversity  as  against  the  unicity 
of  cause  of  tumors.  This  hypothesis  was  ad- 
mitted by  all  without  inquiry  as  to  its  actual  or 
possible  demonstration.  The  Galenists  had  in- 
vented it  to  save  the  atrabile  doctrine,  and  the 
solidists  to  save  the  lymph  doctrine.  This  de- 
generation hypothesis  has  survived  the  wreck  of 
the  two  doctrines,  and  exists  in  the  minds  of 
many  unto  this  day,  as  do  other  false  doctrines. 

Such  were  the  vagaries  of  the  seventeenth  and 
eighteenth  centuries  respecting  the  nature  of  tu- 
mors. The  first  step  in  advance  was  made  by 
Littre  who,  in  1704,  discovered  a  certain  tumor 
to  be  composed  of  adipose  tissue.  Afterwards, 
in  1709,  he  proposed  that  tumors  of  this  genus  be 
named  lipomata.  Here  then  was  a  distinct 
demonstration  of  an  abnormal  development  of  a 
normal  tissue.  But  as  this  was  contrary  to  the 
existing  doctrine,  no  attention  was  paid  to  the 
statement.     Soon  after,  new  observations  showed 


NEOPLASMS.  33$. 

that  other  tumors  were  formed,  by  the  morbid 
increase  of  preexisting  elements,  without  the  in- 
tervention  ot  extravasated  lymph.  It  was  partic- 
ularly the  study  of  encysted  tumors  and  wens 
which  led  to  this  conclusion.  Astruc  and  others 
thought  that  these  tumors  resulted  from  the  dila- 
tation of  lymphatic  vessels.  Louis  rejected  this 
hypothesis,  and  said  that  cysts  were  formed  in 
the  cellular  tissue,  their  walls  being  composed  of 
condensed  cellular  and  not  of  a  new  tissue.  In 
1775,  Girard  attributed  the  formation  of  sebac- 
eous cysts  to  the  obliteration  of  the  ducts  of 
sebaceous  glands.  So  that  gradually,  cysts  and 
wens  were  removed  from  the  category  of  de- 
generating tumors,  since  they  were  supposed  not 
to  be  of  lymphatic  origin.  Finally  scrophulous 
tumors  were  also  removed  from  this  category. 
Then  all  the  other  tumors  were  united  in  a  single 
group  under  the  name  of  fleshy  tumors,  by  the 
advocates  of  the  lymph  theory.  The  extravasated 
and  hardened  lymph  caused  scirrhus,  and  when 
this  lymph  fermented  the  scirrhus  was  changed 
into  cancer.  Certain  tumors  were  supposed  to 
remain  scirrhous  and  therefore  benign,  some 
were  transformed  into  cancer  and  were  therefore 
malignant,  while  others  were  cancerous  and 
therefore  malignant  from  the  beginning.  All  this 
depended  upon  the  freaks  of  the  lymph.     There 


33^  NEOPLASMS. 

was  no  pathoanatomy  in  those  days,  so  this  con- 
fusion respecting  tumors  is  not  to  be  wondered 
at.  Still  some  advance  was  made,  though  of  a 
negative  character,  for  it  consisted  in  the  elimina- 
tion, from  the  group,  of  morbid  states  which 
were  not  properly  tumors. 

The  question  what  is  cancer,  was  put  by  the 
Academy  of  Lyons,  and  a  prize  offered  for  some 
approach  to  its  solution.  Peyrilhe  to  whom,  in 
1773,  the  prize  was  awarded,  announced  as  his 
conclusion  that  it  was  as  difficult  to  define  as  to 
cure  cancer. 

John  Hunter  gave  the  last  stroke  to  the  de* 
generation  theory,  and  though  his  was  also  a 
lymph  theory,  it  was  of  another  kind  of  lymph. 
The  lymph  of  the  solidists  was  a  dead  substance 
cast  away  by  the  lymph  vessels,  a  foreign  body 
which  underwent  lermentation,  etc.,  but  that  of 
Hunter  was  a  transudation,  from  the  blood- 
vessels, endowed  with  the  property  of  coagulat- 
ing and  of  becoming  organized.  Here  then  is  an 
implied  suggestion  that  tumors  might  be  re- 
garded as  organs  superadded  to  the  economy,  for 
he  considered  that  their  tissues  were  nourished, 
as  the  tissues  of  the  normal  parts  of  the  body, 
and  increased  in  size  by  virtue  of  this  nutrition. 
In  his  ''Lectures  on  the  Principles  of  Surgery,''  he 
defines  a  tumor  as  **  a  circumscribed  enlargement 


NEOPLASMS.  337 

in  a  part  from  disease  ;  not  strictly  a  disease  of  a 
natural  circumscribed  part,  as  a  thickened  dis- 
eased gland."  Tumors,  he  says,  '*  seem  to  de- 
pend on  an  accumulation  of  extravasated  co- 
agulable  lymph,  either  in  the  adipose  or  cellular 

membrane  or  both The  increase  of  cancer 

is  much  in  the  same  way."  He  divides  tumors 
into  solid  and  encysted.  Solid  tumors  are  sub- 
divided into  ''three  species:  (i,)  Warts;  (2,) 
Polypi;  and  (3,)  An  entirely  new  substance  in  the 
cellular  membrane,  often  irregular,  and  attached 
by  loose  cellular  membrane  to  the  surrrounding 
parts."  Among  the  encysted  tumors  he  places 
hydatids  and  most  of  the  known  cysts.  He 
classes  tubercles  under  the  head  of  **  spurious 
tumors." 

The  advent  of  Bichat,  and  of  his  creation  of 
general  anatomy,  from  which  pathoanatomy  is- 
sued, changed,  much  for  the  better,  the  aspect  of 
the  question  of  tumors  and  gave  a  basis  for  their 
classification.  His  premature  death  did  not  re- 
tard the  progress  of  general  and  pathoanatomy, 
because  he  had  inspired  his  disciples  with  his 
own  great  zeal  in  the  pursuance  of  these  newly 
created  departments  of  anatomy.  Laenec  was 
the  foremost  of  his  followers  in  the  application  of 
anatomy  to  the  study  of  disease.  It  was  in 
December  1804  that  he  produced  the  ^' note  sur 


338  NEOPLASMS. 

ranatomie  pathologiqiie.'*     This    was   the   starting- 
point  of  general  pathology. 

Laenec  divided  accidental  tissues  into  two 
great  categories:  (i,)  Those  having  analogues 
among  the  normal  tissues ;  (2,)  Those  having  no 
analogues  among  normal  tissues.  Since  then,  for 
brevity,  they  have  been  designated  as  homolog- 
ous and  heterologous  tumors. 

He  reckoned  as  many  homologous  tumors  as 
there  »are  normal  tissues  :  i.  e.  osseous,  fibrous, 
fibro-cartilaginous,  cartilaginous,  cellular  or  adi- 
pose, horny,  etc.,  and  added  hairs  produced  in 
certain  cysts,  the  adventitious  serous  membranes 
discovered  by  Bichat,  and  giving  rise  to  certain 
encysted  tumors,  etc. 

Of  heterologous  tumors  he  numbered  four  ; 
(i,)  Tuberculous;  (2,)  Scirrhous;  (3,)  Encephal- 
oid  ;  and  (4,)  Melanotic. 

He  used  the  term  encephaloid  to  designate 
those  soft  cancerous  tumors  which,  on  gross  in- 
spection, bear  a  resemblance  to  cerebral  sub- 
stance. It  will  be  remembered  that,  even  then, 
soft  cancers  were,  by  many,  regarded  as  degen. 
crated  scirrhous  tumors,  still  believed  to  be  be- 
nign. He'declared  that  the  two  types — encephal- 
oid and  scirrhus — remained  distinct  from  first  to 
last,  and^that  they  were  composed  of  tissues 
which    were   never  interchangeable.     While  on 


NEOPLASMS.  339 

the  one  hand  this  statement  was  an  advance,  dis- 
posing as  it  did  of  the  question  of  fermentative 
degeneration,  on  the  other  hand  it  still  left  a 
doubt  as  to  the  real  character  of  scirrhus.  En- 
cephaloid  and  scirrhus  being  regarded  as  two 
different  diseases,  and  the  former  being  cancerous, 
the  nature  of  the  latter  should  have  been,  but 
was  not,  stated.  What  added  to  the  existing  con- 
fusion was  that  the  two  diseases  had  been  found 
in  the  same  individual,  and  that,  aside  from  the 
difference  in  physical  appearance,  the  symptoms 
of  the  two  were  analogous,  they  showed  the 
same  tendency  to  recurrence,  and  their  termina- 
tion was  the  same.  Clinical  observation  and 
pathoanatomy  were  apparently  at  varience.  The 
microscope  had  not  yet  come  in  aid  to  settle  the 
vexed  question.  It  will  not  seem  strange  then 
that  the  doctrine  of  Broussais,  ascribing  to  in- 
flammatory action  the  formation  of  all  tumors, 
should  have  been  so  readily  embraced.  At 
length  however  it  was  abandoned  and  even  the 
most  devoted  of  Broussais'  pupils  returned  to 
Laenec's  classification. 

While  the  French  were  endeavoring  to  solve 
certain  questions  connected  with  tumors,  the 
English  were  laboring  in  the  same  direction. 
John  Hunter  had  given  the  right  impulse  to  the 
cancer  question,  and  his  successors  were  striving 


340  NEOPLASMS. 

to  determine  which  of  the  many  tumors  should 
be  classed  as  malignant,  and  which  benign. 
Among  these  men  were  Sir  Everard  Home,  Wil- 
liam Hey,  Samuel  Sharpe  and  John  Abernethy. 

In  the  beginning  of  this  century  there  was 
founded  in  London  a  "  Society  for  investigating 
the  nature  and  cure  of  cancer."  That  society 
then  appointed  a  committee,  consisting  of  Doc- 
tors Baillie,  Sims,  and  Willan,  Messrs.  Sharpe, 
Home,  Pearson  and  Abernethy,  with  Doctor 
Denman  as  Secretary,  charged  to  prepare  a  pro- 
gramme consisting  of  thirteen  queries  relating  to 
the  nature,  diagnosis  and  management  of  cancer. 
These  queries  to  be  answered  by  the  profession 
at  large.  The  programme  was  issued  in  the  year 
1802,  and  was  reprinted  in  the  Edinburgh  Med- 
ical Journal,  July  1806.  The  effort  was  fruitless, 
and  the  society  soon  ceased  to  exist,  but  individ- 
uals continued  the  work;  among  them.  Hey, 
Burns,  Home,  Wardrop,  Abernethy  and  Law- 
rence. 

"  Fungus  haematodes  "  regarded  as  non-malig- 
nant by  Hey,  Burns  and  Wardrop  and  as  malig- 
nant by  Young,  was  confounded  with  erectile 
tumors  by  Maunoir,  and  was  not,  for  a  long  time, 
classed  as  a  variety  of  encephaloid  carcinoma. 
Hey  and  Burns  were  the  first  to  call  attention  to 
these  pulsating  tumors  containing  extravasated 


NEOPLASMS.  341 

blood ;  then  Wardrop,  Else,  Bradley,  Young, 
Travers  and  Sir  Astley  Cooper,  contributed  each 
his  share  to  their  study. 

John  Abcrnethy*  appears  to  have  been  the 
first  to  propose  an  anatomical  classification  of 
tumors,  Laenec's  contribution  having  been  made 
several  months  later  (December  1804).  Abernethy 
believed  that  a  proper  understanding  of  the  sub- 
ject could  be  attained  only  by  associated  labor, — 
but  this  was,  for  the  time,  rendered  impossible  by 
the  dissolution  of  the  Cancer  Society, — and  un- 
dertook his  task  with  the  modest  statement  that, 
though  imperfect,  his  arrangement  would,  he 
hoped,  awaken  the  attention  of  many  others  to 
the  question. 

He  defined  a  tumor  as  a  swelling  due  to  some 
new  growth,  and  excluded  mere  enlargements  of 
natural  parts.  He  divided  tumors  into  several 
genera,  the  first  genus  being  sarcoma  to  which  he 
devoted  the  greater  part  of  his  study.  He 
adopted  this  ancient  word  to  designate  those 
growths  having  a  "  fleshy  feel,"  and  recognised 
eight  species: 

I.  Common  vascular  sarcoma;    2.  Adipose  sar- 


*  John  Abernethy ;  Surgical  Observations.  Containing  "An 
attempt  to  form  a  classification  of  tumors  according  to  their 
anatomical  structure."     London  1804. 


342  NEOPLASMS. 

coma ;  3.  Pancreatic  sarcoma ;  4.  Cystic  sar- 
coma ;  5.  Mammary  sarcoma ;  6.  Tuberculous 
sarcoma ;  7.  Medullary  sarcoma  ;  8.  Carcinoma- 
tous sarcoma. 

One  genus  included  osseous  and  cartilaginous 
tumors.     Another  genus  the  cysts. 

Then  followed  the  labors  of  Lawrence  who  re- 
moved from  the  category  of  cancer  '*  benign 
fungus"  of  the  testicle,  of  Sir  Everard  Home 
who  regarded  the  so  called  scirrhus  of  the  pros- 
trate as  simply  a  general  or  partial  enlargement 
of  that  body,  and  of  Sir  Astley  Cooper  who  ex- 
cluded from  the  class  of  cancers  certain  enchon- 
dromata,  tubercles  of  the  testicle,  etc. 

Cruveilhier,  Rokitanski,  Velpeau,  Walshe,  and 
others  of  their  da}^  contributed  largely  to  the 
literature  and  knowledge  of  tumors,  but  that 
which  afforded  the  greatest  aid  in  their  study  was 
the  advent  of  the  cell-doctrine  of  Raspail  (1825) 
and  Royer-Collard  (1826-28),  rendered  possible 
by  the  application  of  the  compound  achromatic 
microscope  (1824)  to  the  study  of  the  human 
tissues  in  health  and  disease.  Most  of  the  old 
questions  so  long  in  debate  were  then  surren- 
dered for  what  became  tangible  and  visible. 
From  that  time  many  entered  the  new  field  of  in- 
vestigation and  there  soon  appeared  exhaustive 
works    on   normal    and   pathohistology,  among 


NEOPLASMS.  343 

which  may  be  cited  those  of  Mandl,  Hassall, 
Lebert,  Wedl,  Vogel  and  Kolliker.  Finally 
Virchow's  cellular  pathology  came  as  a  beacon 
to  give  the  brighter  light  that  guided  the  patho- 
anatomist  in  the  right  direction  to  further  re- 
search. Cohnheim's  publications  represent  the 
advances  which  Virchow's  labors  had  suggested, 
and  the  recent  discoveries  in  embryogeny  now 
come  to  sustain  the  modern  school  of  patho- 
histology  and  serve  to  explain  and  strengthen 
Miiller's  aphorism,  propounded  in  1838,  and 
adopted  by  this  school,  to  the  effect  that  the  sub- 
stance of  all  tumors  has  its  analogue  in  some 
tissue  existing  normally  in  embryonic  or  after- 
life.*    This  is  known  as  the  law  of  Miiller. 

Virchow,  who  published  his  lectures  on  tu- 
mors long  before  the  views  of  Waldeyer  and 
Duval  were  known,  adopted  the  law  of  Miiller, 
and  constructed  the  following  arrangement  of 
*' tumors,"  dividing  them  into  four  groups. 

1.  Tumors  formed  at  the  expense  of  the  ele- 
ments of  the  blood,  for  example  haematomata,  etc. 

2.  Tumors  formed  by  the  retention  of  the  pro- 


*  In  1804  Laenec  had  recognised  some  tumors  having  an- 
alogues among  the  normal  tissues,  but  Miiller  advanced  a  step 
farther  in  declaring  that  the  substance  of  all  tumors  has  its 
analogue  in  the  normal  economy. 


344  NEOPLASMS. 

ducts  of  secretion,  those  which  result  from  the 
dilation  of  secreting  cavities,  due  to  retention  of 
the  product  of  secretion  of  the  glands,  for  exam- 
ple, glandular  cysts,  hygromata,  etc. 

3.  Tumors  which  result  from  the  proliferation 
of  the  elements  of  the  primitive  tissues  of  the 
organism.  This  class  is  divided  into  histioid  tu- 
mors formed  by  a  single  tissue,  organoid  tumors, 
which  reproduce  the  configuration  of  an  organ, 
and  teratoid  tumors,  resembling  by  the  assemblage 
of  different  organs,  an  incomplete  being.  Each 
of  these  classes  is  itself  divided  and  sub-divided. 

4.  The  fourth  group  comprises  mixed  tumors, 
composed  of  the  elements  of  several  of  the  pre- 
ceding tumors. 

The  high  reputation  of  this  great  Master  in 
pathoanatomy  has  caused  his  nomenclature  and 
classification  of  tumors  to  be  largely  accepted  by 
the  profession  without  question.  This  classifica- 
tion ansv/ered  a  good  purpose  twenty-five  years 
ago,  and  was  a  forward  step,  but  the  advances 
since  made  in  pathohistology  forbid  its  continued 
use.  Nevertheless,  there  are  many  phj^sicians 
and  surgeons  who  still  adhere  to  this  arrange- 
ment of  tumors.  In  the  present  light  of  science, 
probably  no  one  sees  better  than  Professor 
Virchow  the  faults  of  this  as  well  as  of  all  other 


NEOPLASMS.  345 

classifications,  and  if  his  occupations  should  per- 
mit him  to  undertake  its  reconstruction,  he 
doubtless  would  do  so  consistently  on  the  anat- 
omical basis  which  does  not  abrogate,  but  rather 
enforces,  Muller's  law.  He  would  probably  aban- 
don the  word  tumor,  and  reject  the  haematomata 
and  also  the  cysts.  He  would  drop  the  terms 
histioid  and  organoid,  place  the  teratoid  growths 
under  the  caption  terata,  and  make  a  very  dif- 
ferent disposition  of  the  mixed  growths  of  his 
fourth  group. 

Forster  has  arranged  tumors  into  three  groups 
as  follows : 

1.  **  Tumors  formed  of  a  simple  tissue,  and 
sometimes  even  of  a  single  element  of  this  tissue; 
for  example,  fibroma,  osteoma,  etc. 

2.  "  Tumors  having  a  complex  arrangement, 
the  analogue  of  which  can  be  found  in  the 
economy  ;  for  example,  papilloma,  cyst. 

3.  "Tumors  formed  of  cells  having  their  an- 
alogues in  the  economy,  but  arranged  in  a  man- 
ner other  than  physiological.  This  group  in- 
cludes sarcoma,  carcinoma,  epithelioma,  lym- 
phatic tumors,  under  which  may  be  classed  the 
organic  lesions  of  typhoid  fever,  tubercle,  syphil- 
itic gummata,  and  true  lymphoma." 

This  arrangement  is  confusing  and  unsatisfac- 
tory, for  genera  belonging  to  entirely  different 


34^  NEOPLASMS. 

orders  are  grouped  together,  and  lesions  of 
typhoid  fever,  tubercle,  and  syphilitic  gummata 
are  included  among  tumors  and  placed  in  the 
third  group  amidst  pathic  conditions  to  which 
they  bear  no  relationship. 

Broca,*  in  his  classification,  goes  back  to 
Laenec's  two  categories  :  homologous  and  hete- 
rologous tumors,  and  begins  with  the  following 
propositions : 

"  I.  All  heteromorphous  tumors  are  heterolog- 
ous.    Ex.  :  cancers ; 

"  2.  All  homologous  tumors  are  homoeomorph- 
ous.     Ex. :  lipomata ; 

"  3.  There  exists  a  third  category  of  tumors 
which  are  at  the  same  time  homoeomorphous 
and  heterologous.     Ex. :  epitheliomata. 

**  Therefore  all  accidental  productions  may  be 
divided  as  follows : 

"  I.  Heteromorphous  tumors. 

"  2.  Homoeomorphous  tumors  :  a,  heterolog- 
ous ;  b,  homologous. 

He  includes  in  his  classification  of  "accidental 
productions  "  many  morbid  states  which  do  not 
properly  belong  to  the  class  tumors  as  the  follow- 
ing synopsis  will  show. 


*  Traitlde  Tumeurs,"  Paris  1866.    Vol.  I. 


broca's  synopsis.  347 

Broca's  classification  of  the 
"accidental  productions." 

CLASS  I.— HoMOEOMORPHOUs  Productions. 
Divided    into:     Homologues,     ist    sub-class; 
Heterologues,  2nd  sub-class. 

Sub-class  I. — Homoeomorphous  and  homologous 

productions. 

Divided  into  two  orders  :     A.  Accidental  productions 

formed  by  the  hypertrophic  development  of  the  organs 

or  of  their  elements.     B.  Accidental  productions  of  new 

formation. 

A.  Accidental  productions  formed  by  the 
hypertrophic  development  of  the  organs  or  of 
their  elements. 

I.  Hypertrophy  affecting  at  the  same  time,  and 
in  a  manner  about  uniform,  all  the  elements  of 
the  organ :  Simple,  general,  or  regular  hyper- 
trophy. 

T3   f     Hypertrophy  of  the  glands,  lymphatic  glands,  mus- 


u 


o 


o 
E 


cles,  heart,  mucous  membranes,  skin,  sub-cutaneous 
tc  •,  cellular  tissue  {elephantiasis),  bones  (hyperostosis), 
■5  I  of  certain  organs  such  as  the  clitoris,  the  labia 
c^   (^  minora,  the  tongue,  etc. 


Of  the  muscles  (very  rare),  tendons  (nodus),  epi- 
dermis  (corns,   callosities),  skin   and   sub-cutaneous 
J  cellular  tissue  (pedunculated   elephantiasic  tumors), 
§   i  mucous  membranes  and  sub-mucous  cellular  tissue 
(mucous    polypi,    condylomata,     hypertrophy  of  the 
pylorus,  etc.). 


348 


broca's  synopsis. 


2.  Hypertrophy  affecting  unequally  the  several 
elements  of  a  complex  organ,  one  of  these  ele- 
ments often  developing  itself  at  the  expense  of 
the  others  :     Partial  or  irregular  hypertrophy. 


o 


Occupying  particularly  the  papillae  (warts). 
Occupying  certain  parts  of  the  derma  (con- 
dylomata). Occuping  the  sebaceous  or  the  sud- 
oriparous glands. 


tj  f  Occupying  the  papillae  (cauliflower  vegetations 
3  ^  I  of  the  external  genital  organs,  of  the  cervix  uteri, 
8  ^  -{  of  the  maxillary  sinus,  etc.,  granulations  of  the 
c  £   I  conjunctiva  .''). 

g  [     Occupying  the  mucous  glands  and  follicles. 


5? 


a.  Irregular  hypertrophy  occupying  a  part  or 
all  of  the  lobes  of  an  acinous  gland  (uniglandular 
adenoma  or  adenoid  tumor)  of  Velpeau. 

b.  Hypertrophy  occupying  many  small  glands 
■{  comprised   in    the   same   region.     Transition  to 

heterology  (multiglandular  adenomata,  polyade- 
nomata  or  glandular  cancroids  of  the  sebaceous, 
sudoriparous,  uterine,  labial,  and  rectal  glands, 
etc.). 


BROCA  S   SYNOPSIS. 


349 


B.  Homocomorphous  and  Homologous  pro- 
ductions of  new  formation. 

That  may  be  divided  into  two  groups,  accord- 
ing as  their  autogenous  elements  are  compound 
or  simple. 


c 

e 

V 

c 

o 

o, 

B 
o 
U 


a.  Tumors  formed "] 
principally  of  vessels  | 
or  of  sanguineous  cavi-  I 
ties  whose  parieties  are  j 
similar  to  the  parieties  | 
of  the  vessels.  J 

b.  Tumors  formed  of  ^ 
a   tissue   analogous   to 


V  in 

^S   O 


that  of  the  uterus,  that 
is    to    say    of    fibrous  ^ 
tissue     and     of    fibro- 
muscular  cells. 


c.  Tumors  formed  of' 
one  or  of  several  ho- 
moeomorphous  and  ho- 
mologous membranes, 
which  circumscribe  one 
or  several  cavities. 


U 


Arterial. 
Venous. 


tn   o   ™ 
PC  *-   £ 


Fibrous  tumors  of 
the  uterus  and  of  the 
neighboring  regions. 


i 


I.  Cysts  developed 
in  preexisting  cavities 
(progeneiic  cysts). 


2.     Cysts  of  entirely 
new    formation     (neo- 
^  genetic  cysts). 


d.  Tumors  formed  of 'j 
the  transitory  or  defin-  (  ^^  i     . 
itive     tissues     of     the  r'^°''^°"'^^^- 
^  teeth.  J 


350 


BROCA  S   SYNOPSIS. 


'  a.  of  adipose  )  a.  Diffuse. — Fatty  infiltration  of  the  organs, 
tissue. . . .  I  b.  Circumscribed. — Lipomata. 


•a 
E 


c 
o 

u 

3 

-o 
o 


in 

«^ 
C 

e 

JJ 
"o. 
E 
c?5 


a.  Reparative   ossifi- 
cation  


io. 


b.  of  osseous 
tissue 


'•"T£ro„10steomata. 


Callus,  new  bone 
necrosis,  etc. 


I.  In  con- 
tinuity with 
the  bone 
(exostoses 
and  osteo- 
phytes). 


2.  With- 
out conti- 
nuity with 
the  bone 
(free  bony 
tumors). 

c.  of  cartilaginous  <  Of   the   skeleton, 

tissue chondromata  )  Of   the   soft  parts. 


d.  of  fibrous  or 
connective  tissue 
or  of  fibro-plastic 
elements,  transi- 
tory, passing 
promptly  into  the 
fibrous  stale. 


Cicatrices.    In- 
flammatory indu- 
ration. Organized 
a.    Productions  {  false  membranes. 


of  traumatic  or  of 
inflammatory  ori- 
J  gin. 


Fibrous  knobs  of 
nerve  trunks  after 
amputation. 


b.  Idiopathic  produc-  ) 
tions    formmg    circum-  >  Fibromata, 
scribed  tumors.  S 


e.  Epithelial  elements,  forming  a^j 
particular   tissue,  without  mixture  f  tt 
of  other  elements.     Transition  to  | 


(^  heterology. 


J 


broca's  synopsis.  351 

Sub-class  II. — Homoeomorphous  and  heterologous 
productions, 

I.  Fibrous  and  fibro-plas-  ttt    *    .  '  *    •     *  • 

..      ,  ^    .       u     »  1  Warty  tumors  of  cicatrices, 

tic  elements  in  about  equal  •(  a      *      •     1  .   u        1 

.  I  Anatomical  tuberculous  tumors. 

"    P  [  Certain  fungi  of  the  dura  mater. 


2.  Autogenous  and  permanent  fibro-plastic  ele-  <  nuclear, 
ments Fibroids.  \  fibrillary. 


3.  Autogenous  epithelial  elements. ...  \  °,  ., !?'... 

T7^;*u^i,««,o  \  of  the  mucous 
Epithelioma,  j  . 

^  f  membranes. 


4.  Disks   with   multiple   nuclei  or   myeloplaxes  )y,    1  •  j. 
forming  the  autogenous  clement. .  . . ' \     ^ 


Simple    melanosis 
5.  Autogenous  pigmentary  elements.  \  (rare  in  man,  com- 
mon in  the  horse). 


'1 


6.  Elements  of  entirely  new  formation  )  Pseudadenomata 
imitating  the  form  of  glandular  culs-de-  >  (or  heteradeno- 
sac,  but  forming  a  heterologous  tissue. . .  )  mata.) 


352  broca's  synopsis. 

CLASS  II. — Heteromorphous  Productions 
(all  are  heterologous). 

A.  Accidental  productions  forming  part  of  the 
economy. 

1.  Tumors  of  a  high  organization,  and  of  a  greater  or 
less  vascularity  of  their  own,  containing  specific  ele- 
ments called  cancerous  elements,  pure  or  mixed  with 
adventitious  elements :     Cancers. 

2.  Tumors  of  a  much  lower  organization,  deprived  of 
vessels  and  containing  specific  elements  called  tuber- 
culous elements :     Tubercles. 

B.  Accidental  heteromorphous  production 
which  does  not  form  a  part  of  the  economy : 
Pus. 

CLASS  III. — Amorphous  Productions. 

'  of  gelatiniform  matter Simple  colloid. 

of  very  small  corpuscles  which  belong  neither  [  Syphilitic 
to  nuclei  nor  to  cells )  gummata. 


of    coagulated    fibrin,    without  (  a^x-,,^  „i  .„  ^t  ♦u     ^ 
^     A          ^     ai^               cu       ^  Active  clots  of  the  ar- 
o  {      tendency  to  fibrous  or  nbro-  <     <.    •  „        e 
cu'        ,      .     •'        .     ..  )    teries  or  of  aneurysms. 

"'  plastic  organization (  ^ 

of  fat  granules,  cholesterincrys-l  Cretacious.     atheroma- 
tals.  sundry  crystals,  and  cal-  calcareous,  and 

sah?"'.^".   ..."  .Tr"'!"  j      ^°P^^^  ^"P°^^'^'  ^^^• 

CLASS  IV. — Encysted  Parasitic  Animals. 

Hydatids. 


NEOPLASMS.  355 

Cornil  and  Ranvier  make  some  improvement 
on  the  preceding  arrangements,  but  instead  of 
gathering  together  like  genera,  they  rank  as  or- 
ders several  of  these  genera.  They  divide  the 
**  tumors  "  into  ten  groups  as  follows  :  * 

Group  I. — "  Comprises  tumors  formed  of  a 
tissue  analogous  to  embryonic  tissue.  We  might 
employ  a  new  word  to  indicate  this  analogy,  but 
we  prefer  to  make  use  of  the  old  word  sarcoma, 
though  it  has  been  employed  in  very  different 
senses  by  different  authors.  This  group  only 
contains  one  genus,  sarcoma,  of  which  there  are 
a  great  number  of  species  and  varieties. 

Group  II. — "Contains  tumors  formed  of  a  tis- 
sue, the  type  of  which  is  found  in  connective 
tissue.  This  tissue  is  sometimes  mucous,  and 
the  tumor  is  called  myxoma,  sometimes  fibrous 
and  called  fibroma  (Verneuil),  or  inoma,  from 
t'ro?,  fibre  (Paget),  sometimes  adipose,  when 
called  lipoma.  In  some  cases  the  tissue  under- 
goes hypertrophic  aberration  affecting  the  size  of 
the  cells  ;  this   is  the  case  in  carcinoma,  which 


*  Cornil  and  Ranvier,  Manual  of  Pathological  Histology, 
second  edition.  Translated  by  A.  M.  Hart.  London  1882.  Na 
change  in  Cornil  and  Ranvier's  classification  of  tumors  has 
been  made  since  their  first  edition  which  was  published  in 
1869. 


354  NEOPLASMS. 

would  be  better  called  alveolar  fibroma ;  in 
others,  the  cells  atrophy,  as  in  tubercle,  glanders 
and  syphilitic  gummata.  This  second  group 
therefore  contains  the  varieties  myxoma,  fibroma, 
lipoma,  carcinoma,  tubercle,  glanders,  and  syphil- 
itic gummata. 

Group  III. — "Contains  tumors  formed  of  car- 
tilaginous tissue,  of  which  there  is  but  one  genus, 
chondroma. 

Group  IV. — *'  Is  composed  of  tumors  formed 
of  osseous  tissue,  osteoma. 

Group  V. — "  Tumors,  formed  of  muscular  tis- 
sue or  myoma,  are  divided  into  two  kinds,  ac- 
cording as  the  fibres  of  new  formations  are 
striated  or  non-striated  :  myoma  of  striated  fibres, 
myoma  of  non-striated  fibres. 

Group  VT. — "Tumors  formed  of  nervous  tis- 
sue are  of  two  varieties :  the  medullary  neuroma 
containing  nerve  cells,  and  the  fasciculated 
neuroma  containing  nerve  tubes. 

Group  VII. — "  In  this  are  tumors  formed  of 
blood-vessels,  or  angioma. 

Group  VIII. — "  Contains  tumors  composed  of 
lymphatic  vessels,  lymphangioma,  and  those 
which  reproduce  the  structure  of  lymphatic 
glands,  lymphadenoma. 

Group  IX. — •'  Contains  tumors  composed   of 


NEOPLASMS.  355 

epithelium  of  new  formation.  They  are  divided 
into  four  varieties  according  as  the  cells  are  ar- 
ranged in  irregular  masses,  epithelioma,  or  in 
papillae,  papilloma,  or  in  culs-de-sac,  adenoma,  or 
in  cavities  of  new  formation,  cysts. 

Group  X.  —Contains  mixed  tumors,  containing^ 
a  great  number  of  tissues ;  they  are  found 
specially  during  intra-uterine  life." 

Cornil  and   Ranvier*  say  **  We wish  to 

treat  simply  from  the  histological  point  of  view, 
and  have  therefore  included  under  the  head  of 
inflammation  and  haemorrhage  what  seemed  to 
us  to  rightly  belong  to  them,  blood-tumors,  hy- 
gromata,  for  example.  We  also  think  we  have  a 
right  to  reproach  Virchow  with  having  invented 
new  words,  drawn  from  gross  physical  characters, 
whereby  to  designate  certain  tumors,  instead  of 
employing  words  representative  of  the  tissues. 
Thus  he  uses  the  word  psammoma  to  signify  a 
tumor  of  the  meninges,  because  it  contains  cal- 
careous granules  similar  to  fine  sand,  and  the 
word  glioma  is  applied  to  tumors  of  the  brain 
because  they  are  of  a  consistency  analogous  to 
glue.  He  thus  departs  from  the  classification 
which  Miiller's  law  suggests,  and  which  we  in- 
tend to  follow  absolutely." 


*  Op.  cit.  pp.  123-124. 


3S6  NEOPLASMS. 

At  page  125,  the  same  authors  write:  "The 
classification  of  tumors  which  we  propose  differs, 
it  will  be  seen,  notably  from  those  hitherto  pub- 
lished. It  is  an  anatomical  classification.  It  can- 
not consequently  serve  to  determine  the  degree 
of  gravity  of  a  tumor.  No  anatomical  classifica- 
tion can  at  present  answer  this  legitimate  desire 
of  the  physician.  To  determine  the  degree  of 
gravity  of  a  tumor,  knowledge  of  the  order, 
species,  and  variety  to  which  it  belongs  can  alone 
be  depended  upon.  The  sole  general  considera 
lion,  which  may  be  advanced  on  the  subject  of 
the  benignity  or  malignity  of  tumors,  is  that  the 
most  serious  are  those  which  determine,  the 
formation  of  a  large  quantity  of  embryonic  ele- 
ments, at  the  expense  of  which  they  grow 
rapidly.  Our  classification  has  the  advantage  of 
being  purely  histological  and  of  being  based  on 
one  law  and  on  one  consideration  which  seems  to 
us  to  be  supreme,  that  is,  the  general  arrange- 
ment of  the  morbid  tissue  and  the  distribution  of 
the  elements  composing  it." 

Cornil  and  Ranvier,  adopting  the  aphorism  of 
Miiller,  endeavor  to  conduct  their  classification 
on  the  anatomical  basis,  but  even  at  the  beginning 
are  inconsistent,  for  instead  of  grouping  the  tu- 
mors in  accordance  with  the  histogeny  of  the 
tissues,  they  mix  connective  tissue  with  epithelial 


NEOPLASMS.  357 

growths  ;  thus  they  place  in  group  second,  in- 
oma,  myxoma,  lipoma  (connective  tissue  growths), 
with  carcinoma  (epithelial  growth),  and  then  add 
tubercle,  glanders,  and  syphilitic  gummata,  which 
have  no  legitimate  place  in  this  group.  Instead 
of  placing  in  one  and  the  same  group,  sarcoma, 
myxoma,  inoma,  lipoma,  chondroma,  and  os- 
teoma, which  are  all  connective  tissue  growths, 
they  scatter  them  in  four  distinct  groups. 

They  make  varieties  of  medullary  and  fasci- 
culated neuromata  which  are  in  reality  species  ; 
and  epithelioma  and  adenoma  which  are  genera 
are  also  set  down  as  varieties. 

They  class  papilloma  as  a  variety  of  epithelial 
growth,  while  in  truth  it  is  a  papillary  or  villous 
inoma,  and  should  be  so  named  and  not  called 
papilloma.  They  include  too  the  cysts,  which 
should  be  placed  under  a  distinct  and  separate 
caption. 

The  mixed  tumors,  described  by  them  as 
formed  especially  during  intra-uterine  life,  belong 
properly  to  the  teratisms  and  should  be  classified 
accordingly. 

This  all  shows  how  inconsistent  and  fallible 
men  can  be  ;  even  those  whose  minds  are  richly 
stored  with  knowledge.  Therefore  nothing  in 
medicine  should  be  taken  for  granted  because  ut- 
tered by  one  high  authority.     Every  assertion, 


358  NEOPLASMS. 

theory,  discovery,  and  new  method  or  process, 
should  be  put   to   the   most   searching  tests  by 
many  laborers,   and,   before   they  are   accepted, 
should  pass  through  the  expurgating  crucible  of 
criticism    which    will   clear   away   the   dross   of 
error   and   misconception,   and   bring   forth    the 
genuine  glitter  of  the  pure  and  precious  truths 
of  science.  This  is  the  right  path  to  advancement. 
Hasse  thinks  that  neoplasms  probably  arise  in 
tissues  in  different  conditions — embryonic,  grow- 
ing, mature,  retrogressive.  They  are  regarded  as 
new  formations  because  they  are  more  or  less  in- 
dependent of   the  matrix  tissue.     They   behave 
like  independent,  isolated  bodies,  except  that  they 
draw  their  sustenance  from  the  organism  ;  they 
have  their  autonomy,  so  that  they  bear  no  relative 
increase  or  decrease  of  size  with  the  organism. 
Examples:  A  neoplasm,  in  a  fat  subject,  does  not 
decrease  in  size  upon  the  supervention  of  emacia- 
tion ;  and  a  neoplasm,  in  a  lean  subject,  does  not 
increase   in  size   upon   the   supervention  of  cor- 
pulency.    "  The    neoplasm    assumes    properties 
distinct  from  its  surroundings,  the  individual  ele- 
ments of   the  growth   become   affected  in  some 
w^ay  and  they  are  rendered  dissimilar  to   their 
neighbors.     There  is  no  limiting  or  directing  in- 
fluence  of   the  surrounding  tissues  on   the  new 
growth.     The  result  is  development  of  a  tissue  of 


NEOPLASMS.  359 

abnormal    type,   a    local    anatomical    misforma- 
tion." 

Cohnheim  is  of  opinion  that  neoplasms  cannot 
be  regarded  as  localised  hyperplasias  because 
they  generally  differ  in  their  histogenesis  from 
the  matrix  tissue,  and  because  this  histogenesis  is 
so  different  from  the  formative  processes  orig- 
inating in  inflammation.  His  views  of  the  em- 
bryonic theory  are  substantially  as  follows : 
Many  forms  of  neoplasms  are  developed  at  all 
ages,  they  originate  too  in  apparently  normal 
tissues,  and  are  due  to  the  persistence  of  embry- 
onic germinal  tissues  in  the  otherwise  mature 
organism ;  taking  their  rise  in  what  may  be 
called  belated  rudiments — foci  of  formative  em- 
bryonic tissue  which  have  not  been  utilised  in 
elaborating  normal  tissues,  and  so  have  lingered 
on  unchanged.  In  other  words  such  a  growth  is 
an  atypical  new-formation  starting  in  a  latent 
embr)^onic  rudiment.  The  germs  of  the  growth 
may  be  very  small  and  elude  observation,  being 
embryonic  cells,  or  may  be  quite  recognisable 
among  the  normal  elements.  These  germs  may 
long  remain  inactive,  but  when  external  condi- 
tions, supply  of  nutriment,  and  relation  to  sur- 
rounding tissues  are  favorable,  they  begin  to 
multiply,   start  into  a  new  life  and  form  a  neo- 


3^0  NEOPLASMS 

plasm.*  Cohnheim's  arguments  in  favor  of  his 
theory  have  explained  the  otherwise  unaccount- 
able heterogeny  of  many  neoplasms.  He  says : 
many  new-growths  are  hereditary ;  they  may 
exist  at  birth  or  develop  in  infanc}'^ ;  they  show  a 
preference  for  sites  where,  in  early  develop- 
mental stages,  complication  of  structure  happens ; 
where  different  epithelial  formations  pass  one 
into  the  other,  as  the  lips,  stomach,  anus,  and 
cervix  uteri ;  or  where  the  entire  -process  of  de- 
velopment is  complex,  as  the  genital  apparatus  ; 
also  the  atypical  structures. 

In  order  to  fully  understand  the  blastodermic 
theory  of  the  development  of  neoplasms,  it  is 
necessary  to  pass  in  review  the  changes  which 
take  place  in  the  human  blastoderm.  The  follow- 
ing, which  exposes  the  most  recent  views  of  the 
subject,  is  abstracted  from  Duval's  physiology. 

"  Originally  the  human  organism  consisted  of 
a  single  cell,  the  ovule,  which  when  fecundated 
begins  to  undergo  certain  transformations,  the 
first  of  which  being  segmentation.  As  soon  as 
the  ovule  is  divided  in  four  segments,  these  limit 
between  themselves,  by  their  slight  separation,  a 
space  called  the  segmentation   cavity.     As  the 


*  It  is  well  known  how  often  new-growths  take  their  start* 
ing  point  from  traumatisms. 


NEOPLASMS.  361 

segmentation  goes  on,  this  cavity  increases  more 
and  more,  and  finally  the  segmented  ovule  be- 
comes a  hollow  sphere  whose  parieties  are  con- 
stituted by  a  layer  of  cells  comparable  to  epithelia. 
The  large  cavity  circumscribed  by  this  layer  of 
cells  still  bears  the  name  of  segmentation  cavity. 
Then  take  place  transformations  which  differ 
somewhat  in  different  animals,  but  may  neverthe- 
less be  brought  to  the  following  type :  that  is  to 
say  to  the  formation  of  a  gastrula.  One  of  the 
hemispheres  of  the  hollow  sphere  becomes  fiat, 
then  is  gradually  invaginated  in  the  interior  of 
the  other  hemisphere.  A  new  cavity,  called  the 
invagination  or  gastrula  cavity,  is  thus  produced, 
w^hich  corresponds  to  the  future  intestinal  cavity. 
"  The  segmentation  cavity  is  then  reduced  to  a 
mere  chink  separating  two  cellular  layers :  the  one 
of  the  layers,  which  corresponds  to  the  interior  of 
the  original  intact  hemisphere  of  the  hollow 
sphere,  is  called  the  external  layer,  the  other, 
which  corresponds  to  the  interior  of  the  invagi- 
nated hemisphere  is  called  the  internal  layer. 
Soon  the  internal  layer,  by  multiplication  of  its 
cells,  is  divided  into  two  layers,  one  of  which  be- 
ing the  internal  layer  proper,  and  the  other  the 
middle  layer  or  mesoblast.  The  mesoblast  there- 
fore occupies  a  position,  in  what  was  the  segmen- 
tation cavity,  between  the  internal  and  external 


362  NEOPLASMS. 

layers.  Such  is  the  origin  and  development  of  the 
blastodermic  vesicle,  and  such  are  the  relations 
of  its  three  layers.  The  epiblast  or  external 
horny  layer  retains  its  cellular  character,  and 
from  it  is  derived  the  epidermis. 

"  The  entoblast  or  internal  layer  furnishes  the 
epithelium  of  the  future  intestinal  mucous  mem- 
brane and  of  that  of  its  annexes,  of  the  great 
majority  of  glands,  and  of  the  lungs. 

"The  mesoblast  or  middle  layer.  The  cells  of 
of  this  layer  undergo  much  more  complicated 
transformations  than  those  of  the  other  two 
layers.  Some  of  them  are  transformed  into  nerve 
tissue,  into  muscle  tissue,  and  into  all  the  forms 
of  connective  tissue  ;  others  preserve  their  cellu- 
lar state,  but  are  changed  in  form  and  diffused  in 
the  fibrous  element  of  connective  tissue,  **  they 
are  called  embryonic  or  mesoblastic  cells — cells 
of  tendons,  cartilage,  bone —  ;  the  others  swim  in 
a  fluid — blood  cells,  etc."  * 

Rindfleisch  and  Lancereaux  based  their  classi- 
fications of  the  new-growths  upon  the  derivative 
tissues  of  the  blastoderm,  and  divided  these  new- 
growths  into  two  great  classes ;  (i,)  that  in  which 
the  generative   tissue  is  derived  from  the  meso- 


♦  Mathias  Duval.     Cours  de   Pysiologie.     Sixieme  edition. 
Paris,  1887. 


NEOPLASMS.  363 

blast ;  (2,)  that  in  which  the  generative  tissue  is 
derived  from  the  entoblast  and  epiblast.  The 
first  being  formed  of  connective  tissue,  the  second 
of  epithelium,  of  epidermis,  or  of  their  derivatives. 
Hallopeau  adopted  this  basis  of  classification  in 
the  first  edition  of  his  work,  but  in  the  second 
edition  he  says:  "to-day  the  soundness  of  this 
division  may  be  doubted  in  view  of  the  late  em- 
bryogenic  researches  of  Waldeyer,  showing  that 
the  entoblast  and  mesoblast  are  derived  from  the 
invagination  of  the  epiblast;  in  that  case  the 
mesoblast  has  not  the  same  individuality  as  the 
others,  for,  elements  of  different  nature  are 
therein  united.  Duval  had  arrived  independently 
at  the  same  conclusion. 

In  his  work  on  Physiological  Chemistry  (1880), 
Gamgee,  in  treating  of  the  epithelium  of  the 
mucous  membranes,  says  : 

"  This  epithelium  is  mainly  derived  from  the 
hypoblast,  though  in  some  cases  it  takes  its 
origin  in  the  epiblast  (epithelium  of  mouth  and 
salivary  glands),  in  others  from  the  mesoblast 
(certain  portions  of  the  epithelium  of  the  genito- 
urinary tract).  In  short,  the  epithelium  of  the 
mucous  membranes  is  possessed  of  diverse  chem- 
ical attributes  and  is  developed  in  several  ways ; 
it  does  not  therefore  possess  any  common  charac- 
ters which  permit  of  a  general  description." 


364  NEOPLASMS. 

The  clinical  basis  is  out  of  the  question  because, 
if  an  arrangement  were  attempted  on  such  a 
foundation,  the  malignant  and  non-malignant 
growths  would  have  to  appear  under  separate 
heads  ;  for  instance,  epithelioma  and  carcinoma 
would  have  to  be  placed  in  the  same  order  as 
sarcoma,  etc.  It  would  be  against  all  rules  of 
nosography  to  arrange  growths  in  accordance 
with  their  benignity  or  malignity,  for  this  belongs 
to  prognosis  which  occupies  its  proper  rank  in 
methodical  arrangement. 

Rindfleisch  still  adheres  to  the  blastodermic 
basis,*  and  defines  a  tumor  as  **  an  excess  of  de- 
generative local  development." 

The  classification  which  he  now  promulgates 
is  based  upon  the  duality  of  the  embryonic  ele- 
ments (His.),  namely,  (i,)  archiblastic  tissues, 
which,  besides  the  epithelial  casing  of  the  epiblast 
and  entoblast,  include  the  muscular  and  nervous 
elements  that  are  generally  credited  to  the  meso- 
blast;  (2,)  the /<3:r<a;^/<2^^/^  tissues,  the  products  of 
the  peripheric  vessel-forming  matrix,  of  the  area 
opaca  of  the  embryo,  which  from  the  periphery 
grow  into  archiblastic  layers,  and  serve  to  bind 
them  together  and  nourish  them.     If,  says  Rind- 


*  Ed.  Rindfleisch.    Elements  de  Pathologie.     Traduction 
Fran9aise  du  Docteur  J.  Schmitt.  Paris  1886. 


NEOPLASMS.  365 

fleisch,  this  theory  be  accepted,  a  natural  and 
fruitful  division  of  tumors  may  be  made  into  two 
groups:  "The  first  group  include  tumors 
which  are  exclusively  the  products  of  the  inter- 
mediary apparatus  of  nutrition — the  primitive 
parablasts.  From  the  beginning  they  show  their 
connection  with  the  vascular  system,  by  forming 
around  a  vessel  a  little  focus  of  embryonic  tissue 
rich  in  cells.  This  may  in  time  produce  the  high- 
est types  of  the  tissues  of  the  parablastic  series. 
After  this  manner  are  produced  lipoma,  fibroma, 
myoma,  enchondroma,  endothelioma,  angioma, 
etc.  But  in  a  great  number  of  cases  the  neoplasm 
does  not  reach  full  development,  and  the  tumor 
remains  formed  of  an  imperfect  connective  tissue 
such  as  is  found  in  inflammatory  neoplasms — 
connective  tissue  with  round  or  fusiform  cells — 
this  is  sarcoma.  This  imperfect  maturation  of 
tissue  gives  a  new  criterion  of  the  degree  of  de- 
generation, and  irregularity  of  development.  In 
fact  the  amount  of  production  is  in  inverse  ratio 
to  the  perfectness  of  the  tissue.  The  excessive 
formative  activity  seems  to  have  the  one  object 
of  producing  an  enormous  amount  of  cells.  It  is 
in  this  way  that  the  disease  destroys  an  organ 
and  pervades  the  whole  economy.  In  this  strug- 
gle, the  individual  development  of  the  cell  goes 
on  with  difficulty.     Still  the  most  exuberant  sar- 


366  NEOPLASMS. 

comata  have  a  tendency  to  reproduce  certain 
characters  of  the  site  where  they  are  developed — 
as  ossification,  pigmentation,  etc. 

"The  second  group  includes  the  epithelial  tu. 
mors.  Here  the  epiblast  and  entoblast,  either 
alone  or  mixed  with  the  parablasts,  determine 
the  essential  nature  of  the  tumor.  Here  too  are 
produced  many  young  epithelial  cells  which 
rarely  reach  full  development  but  resemble  the 
epithelial  cells  which  are  proper  to  the  site. 
Thus  are  formed  the  subdivisions  of  adenomata. 
Much  more  frequent  are  the  true  carcinomata  in 
which  the  epithelial  proliferation  is  completely 
atypical  and  very  rapid  and  abundant,  the  young 
cells  inordinately  accumulating  on  the  chosen 
ground.  Carcinomata  and  sarcomata,  in  conse- 
quence of  this  luxuriant  cell  proliferation,  have  a 
common  property  which  allows  them  to  be  in- 
cluded in  the  same  clinical  group  as  that  of 
medullary  tumors." 

It  is  thus  Rindfleisch  reaches  his  classification 
which  is  as  follows : 


neoplasms.  367 

Rindfleisch's  Classification  of  Tumors. 

Group  I.    Hyperplastic  Tumors. 
Site;  Bone,  Skin,  Glands. 

1.  Enchondrosis 

2.  Exostosis 

3.  Verruca 

4.  Papilloma 

5.  Hypertrophied    glands    with   equal    develop. 

ment  of  all  their  tissues. 

a.  Lymphoma  (lymph-glands,  spleen). 

b.  Struma  hyperplastica  (thymus,  prostate). 

c.  Cysts  by  retention  (atheroma,  mucous  polyps 

of  the  intestines  and  uterus).* 

Group  II.    Heteroplastic  Tumors. 
(True  tumors). 

A.  Tumors  issued  from  the  vasculo-connective 
substance — Parablastic  neoplasms  (His).  Histioid 
tumors  (Virchow). 


*  Here  then  is  a  series  of  growtlis  which  Rindfleisch  classi- 
fies as  tumors,  but  in  the  second  group  (true  tumors),  is  an 
implied  statement  that  the  first  group  consists  of  tumors  that 
are  not  tumors.  This,  however,  is  but  a  venial  fault  as  com- 
pared with  others  contained  in  this  very  unsatisfactory  classi- 
fication. 


368  NEOPLASMS. 

a.  Where  the  tissues  reach  perfect  maturation. 

1.  Fibroma 

2.  Lipoma 

3.  Enchondroma 

4.  Myxoma 

5.  Angioma 

6.  Osteoma 

7.  Endothelioma. 

b.  Where  the  tissues  do  not  reach  perfect 
maturation. 

I.  Sarcoma 

a.  Fusocellular  sarcoma  (small  cells). 

b.  Fusocellular  sarcoma  (large  cells). 

c.  Simple  globocellular  sarcoma. 

d.  Lymphadenoid  globocellular  sarcoma. 

B.  Tumors  having  their  origin  in  the  tegu- 
mentary  or  glandular  epithelium  {archiblastic 
heteroplasms). 

I.  Epithelioma 

a.  Pavement  epithelium  tumors, 

b.  Cylindrical  epithelium  tumors. 

c.  Glandular  epithelium  tumors. 

There  stops  this  nevsr  arrangement  of  tumors. 
It  is  so  obviously  incomplete,  inconsistent,  and 
unsatisfactory  that  an  extended  commentary 
thereon  would  be  superfluous. 


NEOPLASMS. 


369 


I.     Connective 
tissue  tumors. 


Mr.  Butlin,  excluding  the  cysts,  divides  tumors 
into  two  orders  and  fourteen  genera  as  follows:* 

1.  Lipoma 

2.  Fibroma 

3.  Chondroma 

4.  Osteoma 

5.  Myxoma 
-j    6.  Lymphoma 

7.  Myoma 

8.  Neuroma 

9.  Angeioma 

10.  Sarcoma 

11.  Endothelioma 

II.      Epithelial  j  "•  PT"°™^ 

^  K  i^.  Adenoma 


tumors 


(  14.  Carcinoma, 


Six  modern  classifications  of  tumors — all  dif- 
ferent— ,  from  Virchow  to  Butlin  and  Rindfieisch, 
are  given  for  comparison.  If,  in  the  whole  range 
of  nosography,  there  existed  only  this  diversity 
in  arrangement,  it  would  be  sufficient  to  warrant 
a  loud  call  for  a  better  understanding  among  in- 
vestigators, for  associated  labor,  and  for  a  general 
consense  of  views  in  the  profession,  as  the  only 
means  to  put  an  end  to  this  confusion  of  names 


*  Article  Tumors,  by  Henry  Trentham  Butlin,  F.  R.  C.  S„ 
in  the  International  Encyclopedia  of  Surgery,  1884. 


370  NEOPLASMS. 

whose  outcome  has  been  confusion  of  ideas. 
Only  one  classification  of  tumors  is  really  wanted 
and  this  should  be  compiled,  partly  from  those 
now  existing,  and  partly  from  the  new  material 
which  must  come  forth  as  a  result  of  the  study 
entailed  by  such  compilation. 

The  foregoing  statements  render  it  clear  that 
the  law  of  Miiller,  or  the  blastodermic  theory 
cannot  stand  for  the  foundation  of  any  classifica- 
tion. However,  neither  the  former  nor  the  latter 
should  be  lost  sight  of,  for  they  both  afford  great 
aid  alike  in  the  study  of  morbid  growths  and  in 
their  arrangement.  The  true  basis  of  the  classi- 
fication should  be  anatomy  in  its  broadest,  most 
comprehensive  sense,  leading  from  biogeny  to 
pathogeny.  It  is  upon  this  basis,  in  accordance 
with  the  dominant  structure  in  their  composition, 
that  the  arrangement  of  neoplasms,  (as  far  as 
genera),  has  been  made  in  the  table  of  morbid 
states  and  morbific  processes,  which  is  offered 
only  as  a  suggestion  of  a  ground-work  for  the 
classification  of  diseases. 

In  the  table  of  morbid  states  and  morbific  pro- 
cesses Neoplasmata  stand  for  class,  and  this  class 
is  divided  into  five  orders:  i,  Desmoneoplas- 
mata ;  2,  Myoneoplasmata ;  3,  Neuroneoplas- 
mata;  4,  Angioneoplasmata ;  and  5,  Epithelioneo- 
plasmata :  and  fourteen  genera.     Thus  indicating 


NEOPLASMS.  371 

the  tissues  of  which  the  growths  are  chiefly  com- 
posed. 

The  first  order  consists  of  eight  genera  ;  the 
second  order,  of  one  genus  ;  the  third  order,  of 
one  genus ;  the  fourth  order,  of  one  genus  ;  and 
the  fifth  order,  of  three  genera. 

The  third  genus  of  the  first  order  is  named 
inoma, — from  i'?,  zVo?,  fibre — ,  as  suggested  long 
ago  by  Sir  James  Paget.  This  term  is  preferable 
to,  because  more  exact  than,  fibroma  which  is  a 
hybrid.  However,  in  the  table  it  appears  in 
brackets. 

The  fifth  genus  of  this  first  order  is  named 
neuroglioma  instead  of  the  original  glioma  of 
Virchow.  Neuroglioma  was  used  by  Klebs, 
Heller,  and  Renaut  (1885).  They  employed  this 
word  because  they  thought  that  the  growth  con- 
tained nerve  elements.  Ziegler  and  others  de- 
nied that  neurogliomata  contain  nerve  elements. 
Hallopeau  insists  upon  the  use  of  glioma  because, 
as  he  says,  it  contains  no  nerve  elements. 

The  term  neuroglioma  is  used  here  simply  be- 
cause the  growth  it  is  intended  to  designate  is 
composed  of  neuroglia,  nerve-glue.  Used  in  such 
a  sense  this  word  will  surely  not  indicate  that  the 
growth  in  question  contains  nerve  elements  other 
than  nerve-glue.  Glioma  is  objectionable  because 


372  NEOPLASMS. 

it  means  a  growth  composed  of  glue  without  in- 
dicating the  kind  of  glue. 

The  second  order,  myoneoplasmata,  consists  of 
only  one  genus,  myoma,  and  this  genus  of  two 
species,  (i,)  rhabdomyoma,  composed  chiefly  of 
striated  muscular  fibres,  and  (2,)  leiomyoma, 
composed  chiefly  of  smooth  muscular  tissue. 

The  third  order,  neuroneoplasmata,  consists  of 
one  genus,  neuroma,  and  this  genus  of  two  spe- 
cies, (i,)  medullary  neuroma,  containing  nerve 
cells;  (2,)  fasciculated  neuroma,  containing  nerve 
tubes. 

The  fourth  order,  angioneoplasmata,  consists 
of  one  genus,  angioma,  and  this  genus  of  two 
species,  (i,)  haemangioma,  composed  chiefly  of 
blood  vessels ;  (2,)  lymphangioma,  composed 
chiefly  of  lymph  vessels. 

The  fifth  order,  epithelioneoplasmata,  consists 
of  three  genera,  (i,)  epithelioma,  (2,)  carcinoma, 
(3,)  adenoma.  Each  genus  has  its  species  and 
these  their  varieties.  Some  of  these  species  are 
now  in  dispute,  and  it  is  hoped  that  the  question 
of  their  retention  or  rejection  will  very  soon  be 
settled.  The  epithelioneoplasmata  may  be  said 
to  be  panblastic,*  that  is  to  say  that  they  are  de- 


*  Panblastic  (Clymer). 


BLASTOMATA.  373 

rived  from  the  meso  and  from  the  ento  and  epi- 
blast. 

VI.  Blastomata. 

The  reasons  for  suggesting  the  term  blastoma 
are  given  at  page  58. 

Blastomata  are  detached  from  neoplasmata,  be- 
cause of  the  fact  that  neoplasmata  spring  from 
the  normal  tissues  of  the  body  generally  without 
the  intervention  of  extraneous  substances,  while 
the  blastomata  are  now  all  regarded  as  infective 
in  character  and  as  proceeding  from  parasitic 
invasion.  From  the  point  of  view  of  the  Bacteri- 
ologists, blastomata  have  a  better  right  to  the  ti- 
tle neoplasmata  than  the  growths  now  bearing 
that  name.  In  the  one  case  the  growths  are  en- 
dogenous (native),  in  the  other  exogenous,  (for- 
eign invaders  compelling  the  organism  to  build 
their  dwellings  which  they  consume  and  de- 
stroy.) 

The  seventh  genus  of  blastomata,  actinomy- 
cosis, is  a  disease  of  the  lower  animals,  but  it  oc- 
casionally invades  the  human  body.  The  para- 
sites actinomyces  enter  the  body  with  the  food 
taken,  and  effect  lodgment  in  the  tissues  of  the 
mouth  through  an  accidental  abrasion,  multiply, 
cause  inflammation  of  the  surrounding  tissues 
and  soon  a  neoplasm,  resembling  a  tuberculous 


374  BLASTOMATA. 

nodule,  is  developed  which  consists  chiefly  of 
round  cells.  The  neoplasm  may  go  on  increasing 
in  size  or  may  break  down  and  suppurate.  In  the 
slimy  detritus  little  pale-yellow  grains  of  the 
fungus  may  be  detected.  The  organism  may 
also  occur  in  nodular  tumors  in  the  lungs,  and 
subcutaneous  and  intermuscular  tissues.  It  is 
the  cause  of  **  wooden  tongue  "  and  also  of  dis- 
eases which  have  been  described,  before  their 
true  nature  was  understood,  as  bone-canker,  bone 
tubercle,  osteo-sarcoma,  etc.,  (Crookshank). 

The  eighth  genus  of  blastomata,  rhinoscleroma, 
was  formerly  confounded  with  syphilis  and  lupus, 
but  it  greatly  differs  from  them  in  its  anatomical 
characters,  and  is  not  in  the  least  degree  con- 
trolled by  antisyphilitic  medication.  It  has  been 
observed  in  Austria,  Hungary,  Italy,  and  Central 
America.  Hebra  and  Kaposi  described  it  in 
1870,  and  since  that  time,  the  subject  has  been 
largely  discussed,  particularly  by  Mikulicz, 
Frisch,  Chiari,  Klebs,  Auspitz,  Eppinger,  Pel- 
lizari,  Alvarez,  and  Rindfleisch.  (Cornil  and 
Babes). 

Rhinoscleroma  is  characterized  by  a  thickening 
and  induration  of  the  nasal  septum  and  mucous 
membrane,  of  the  integument  of  the  nose  and 
lips,  and  of  the  pharyngo-laryngeal  mucous  mem- 
brane.    It  begins  in  the  nose  and  finally  invades 


BLASTOMATA.  375 

the  other  parts.  It  shows  itself  under  the  form 
of  smooth  or  granulous,  hard,  elastic,  and  shiny 
nodosities  of  light  red  or  gray  color  and  painful 
under  pressure.  These  growths  extend  deeply 
into  the  derma  and  slightly  resemble  keloides^ 
showing  neither  hairs  nor  glandular  mouths.  The 
neighboring  parts  are  tumefied,  the  nose  is  flat- 
tened and  enlarged  at  its  anterior  extremity  ;  the 
wings  of  the  nose  are  stiff  and  immovable ;  and 
the  nasal  orifices  are  narrowed.  The  upper  lip 
is  indurated  from  invasion  of  the  disease  which 
may  reach  the  gums  and  buccal  membrane,  at 
the  same  time  that  the  infection  is  propagating 
itself  from  the  nasal  fossae  to  the  palatine  cur- 
tain, to  the  pharynx  and  even  the  larynx.  A 
glottic  stenosis  necessitating  trachoeotomy  may 
even  be  the  result.  The  progress  of  rhinoscleroma 
is  very  slow,  the  primitive  nodule  may  be  four  or 
five  years  in  reaching  a  superficial  extent  of  four 
or  five  centimetres.  There  are  cases  of  fifteen 
or  twenty  years  standing.     (Cornil  and  Babes.) 

According  to  Auspitz,  Alvarez,  and  Rind- 
fleisch,  the  skin  in  rhinoscleroma  is  infiltrated 
with  small  cells,  its  vessels  are  sclerosed  and  im- 
bedded in  the  same  cells.  It  contains  also  proto- 
plasmic polynucleated  giant  cells,  and  also  bac- 
teria and  hyaline  bodies.    Alvarez  has  lately  said 


376  CYSTS. 

that  he  is  disposed  to  look  upon  these  as  dilated 
lymphatics  rather  than  cellular  elements. 

VII.  Cysts. 

The  cysts  are  detached  from  the  class  neoplas- 
mata  because  cysts  that  are  not  parasitic  or  tera- 
tic  are  not  neoplastic,  and  the  parasitic  and  tera- 
tic  cysts  should  be  placed  respectively  in  the 
classes  Parasiti  and  Tcrata. 

Most  of  the  recent  writers  upon  neoplasms  ex- 
clude the  cysts  from  the  caption  neoplasmata. 
A  cyst  is  a  cavity  whose  contents  are  circum- 
scribed by  fibrous  tissue,  or  some  other  more  or 
less  complex  structure,  with  or  without  a  lining- 
of  epithelium  or  endothelium,  according  to  its 
genesis. 

Sir  James  Paget*  separates  the  cysts  from  the 
tumors,  but  includes  parasitic  and  teratic  cysts  in 
the  one  class  cysts,  as  have  done  most  other 
writers. 

Mr.  Butlin  f  divides  cysts  into : 


*  Lectures  on  Surgical  Pathology,  edited  by  Dr.  Turner, 
t  Loc.  Cit. 


CYSTS.  377 

I.  Cysts  formed  by  distension  of  previously 
existing  sacs  or  tubes. 

1.  Retention  cysts. 

2.  Exudation  cysts. 

3.  Blood  cysts. 

4.  Lymph  cysts. 

II.  Cysts  of  new  formation. 

1.  Extravasation  cysts. 

2.  Parasitic  cysts. 

3.  Cysts  formed  in  areolar  tissue. 

4.  Cysts  formed  by  union  of  papillary  processes. 

5.  Cysts  from  changes  in  cells. 

III.  Cysts  of  uncertain  origin. 

Are  not  the  cysts  (II.  3.)  formed  in  areolar  tis- 
sue the  same  as  (I.  2.)  the  exudation  cysts,  and 
{I.  4.)  the  lymph  cysts  ? 

Parasitic  cysts  have  no  place  in  II,  for  they  be- 
long properly  to  the  caption  Parasiti. 

Cysts  of  uncertain  origin  (III,)  naturally  sug- 
gest that  an  endeavor  should  be  made  to  find  the 
origin  of  these  cysts  in  order  that  they  be  named 
and  rightly  classified. 

Retention  cysts  are  exemplified  by  the  glandu- 
lar cysts  formed,  in  preexisting  epithelial  cavi- 
ties, by  organic  or  mechanical  closure  of  a  gland 
duct,  causing  an  accumulation  of  its  natural  se 


378  CYSTS. 

cretion  behind  the  obstruction,  and  dilatation 
into  a  cyst.  The  retention  cysts  occur  in  the 
skin,  mamma,  uterus,  intestine,  and  kidney* 
Canals  lined  with  epithelium,  such  as  the  bile 
ducts,  ureters,  vermiform  appendix,  seminal 
tubes,  etc.,  develop  into  cysts  by  local  dilatation 
from  obstruction. 

Endothelial  cysts  are  often  classed  as  retention 
cysts,  but  are  not  of  that  nature.  They  are 
properly  exudation  cysts,  and  occur  either  in 
natural  spaces  of  the  connective  tissue,  such  as 
bursae  and  tendon  sheaths,  in  false  membranes, 
or  in  obstructed  lymphatics,  and  their  contents^ 
though  varying  with  their  mode  of  origin,  consist 
generally  of  lymph. 

Blood  cysts  are  due  to  haemorrhage  in  pre- 
existing cysts,  in  closed  cavities,  or  in  connective 
tissue  which  eventually  encloses  completely  the 
extravasated  blood.  They  are  all  therefore  blood 
extravasation  cysts. 

Lymph  cysts,  commonly  called  hygromata,  are 
the  same  as  endothelial  cysts,  and  are  the  out- 
come of  obstruction  of  lymph  vessels,  or  of  dila- 
tation of  lymph  spaces.  They  may  also  be  lymph 
extravasation  cysts. 

Degeneration  cysts  result  from  a  necrotic  pro- 
cess. They  occur  in  the  substance  of  organs  and 
sometimes  of  tumors,  and  their  contents  are  the 


CYSTS.  379 

products  of  disintegration  of  the  substance  of  the 
organ  or  of  the  tumor. 

Cysts  formed  around  foreign  bodies  such  as 
bullets,  etc.,  and  around  parasites,  should  be 
classed  under  their  appropriate  captions  and  not 
with  neoplasmata. 

Waldeyer  and  Malassez  regard  ovarian  cysts  as 
epitheliomata.  If  this  view  be  correct,  such 
cysts  should  be  classed  as  varieties  of  epithelio- 
mata. 


38o 


CONCLUSIONS. 


Among  the  conclusions  drawn  from  the  pre- 
ceding considerations  are  : 

1.  That  the  systematic  arrangement  of  diseases 
upon  a  proper  basis  must  give  to  medicine  an  as- 
sured position  among  the  sciences  ;  and  that  even 
in  its  imperfect  state,  it  has  contributed  marvel- 
ously  to  the  advancement  of  medical  art  during 
this  century. 

2.  That  the  only  stable  basis  for  nosography  is 
anatomy. 

3.  That  an  accurate  description  and  an  exact 
definition  of  diseases  are  essential  to  a  precise 
and  practical  nosography. 

4.  That  a  nomenclature,  to  be  satisfactory, 
must  not  admit  the  application  of  the  names  of 
men  to  diseases,  or  any  name  which  does  not  con« 
vey  an  intelligible  idea  of  a  morbid  condition. 


CONCLUSIONS.  381 

5.  That  the  nomenclature  of  diseases  can  be 
much  improved  only  after  a  very  great  change 
for  the  better  shall  be  made  in  the  fundamental 
science  and  associated  arts  of  medicine. 

6.  That  the  most  useful  and  practical  classifica- 
tion of  diseases  is  that  in  which  these  are  grouped, 
in  accordance  with  the  apparatuses  of  the  body, 
into  families,  branches  of  families,  classes,  orders, 
genera,  species,  sub-species,  varieties,  and  sub- 
varieties. 

7.  That  the  purpose  of  the  nosographer  should 
be  to  guide  the  practising  physician  to  the 
end  of  any  case  of  disease. 

8.  That  a  complete  nosography  should  include 
the  history,  pathoanatomy,  diagnosis,  prognosis, 
and  treatment  of  diseases,  and  for  ready  refer- 
ence, should  contain  not  less  than  five  synoptical 
tables  :  (i,)  21  synposis  of  the  morbid  states  and 
morbific  processes  of  the  body  ;  (2,)  a  synopsis  of 
the  genera  and  species  of  diseases ;  (3,)  a  synop- 
sis of  the  classes,  orders,  genera,  species,  sub- 
species, varieties,  and  sub-varieties  of  diseases; 
{4,)  a  synopsis  of  the  aetical  factors  of  diseases  ; 


3^2  CONCLUSIONS. 

and  (5,)  a  synopsis  of  the  symptoms  and  signs  of 
diseases ;  also  a  full  alphabetical  index. 

9.  That  any  system  of  general  nosography,  to 
be  of  utility  to  scientific  investigators,  practising 
physicians,  and  vital  statisticians,  should  be  the 
result  of  the  conjoint  labors  of  the  medical  pro- 
fession of  all  the  civilized  nations  of  the  world. 


INDEX. 


383 


Abortus    . 

103,  158 

Abscess 

82 

Acetonaemia 

46,  264 

Achores 

82 

Acrotica 

161 

Acrotismus 

152 

Actinomycosis 

49.373 

Adenoma 

49 

Adenoses       .            .            . 

165 

Adipsia 

99.  114 

Adynamiae 

,            ,           108,  III,  126 

Aedopsophia 

104 

Acdoptosis 

157 

Aerifluxus 

104 

Aesthetica 

149 

Agenesia              ,            .            , 

.         156 

Ageustia 

...              114 

Agheustia 

.            .            .98 

Agrypnia 

.      102,  153 

Algor       .            ,            .            . 

100 

Alibert's  System 

165 

Alopecia 

82,  106 

Alphosis 

164 

Alusia      .            .            •            . 

148 

Alvifluxus, 

.            .            .              103 

Amaurosis 

98,  113,  150 

Amblyopia 

98 

Amenorrhoea 

115 

Amentia        .            .            .            , 

102,  112 

American  Med.  Assoc,  discussion  c 

)n  the  adoption 

of  a  system  of  nomenclature, 

i76> 

Ammoniaemia 

. 

46,  264 

Amnesia 

lOZ 

Amphimerina 

,            . 

95 

Amputatura 

94 

Anacatharsis 

, 

105 

Anaesthesia 

98,  114 

Anaphrodisia, 

,            , 

99,114 

Anasarca 

82,  104,  112 

Anatomy       .            .            .            . 

. 

31 

Anchylosis 

82 

Anepithymiae 

. 

99.  127 

Anetus     .            .            . 

139 

Aneurysma    .            .            .            . 

•  * 

92,  115,  147 

Angina     .... 

98 

Angioma        .            . 

. 

49 

Angioses 

.        16S 

Anhelatio       .            .            .            . 

. 

97,  117,  125 

Anorexia 

99.  114 

Anosmia        .            .            ,            . 

• 

98.  114 

Antipathia 

102,  153. 

Anthracia 

I            • 

I4S 

Anthrax               .            .            . 

92,  141 

Anthroponosography 

. 

34 

Anthropophysiography 

31 

Anxietas 

. 

.      100,  153 

Aphelxia              .            • 

14^ 

Aphonia 

. 

99,  114,  136 

Aphoria 

157 

Aphorisms  of  Linnaeus 

. 

1 8a 

Aphtha 

83. 

95,  no.  144 

INDEX. 

385 

Apocenosis     .... 

.      115.  125 

Apolepsis 

83 

Apomyttosis 

97 

Apoplexia 

83,  99,  III,  154 

Apparatus — definition  of 

64 

Apparatus — circulatory,  disturbances 

in            .           .47 

Ardor              .            .            .            . 

100 

Aridura 

104 

Arthritis          .             .             .             , 

100,  124 

Arthrocace 

94 

Arthrodynia 

no 

Arthropuosis        ., 

•            .110 

Arlhrosia        .            .            »            • 

144 

Ascarides              .            . 

83 

Ascites            .            . 

.      105.  113 

Asphyxia 

99 

Asthenia         .            .            .            . 

99 

Asthma 

.    83,98,111,125,138 

Athroisaemia 

.       47.  324 

Atrophy 

.     47,52.55.104,112 

Auante             .            .           .            . 

83 

Aurigo       .            . 

106,  127, 164 

Auxesis            .            .            .            . 

47,  52,  326 

Azoteneses            , 

.       119 

Bacteria      .           •           .           . 

.    298-323 

Ballismus 

.      153 

Barber-surgeon           . 

41 

Basis  of  classification 

.      214 

Baumes'  system 

118 

Beriberia 

97.  153 

Bex       .            ,            .            .            . 

137 

Bezoardus              ,            ,            , 

.      133 

Bibliography,  nosographical 

,            ,    200-211 

30O                                        INDEX. 

Biothalmy              »            .            »            .            ; 

37 

Blastomata      ,            .            . 

, 

49.  373 

Blennoses 

.       166 

Blennorrhoea                .            ,            .            -. 

. 

155 

Blepharoptosis       ..... 

93 

Blood,  alterations  in  composition  of 

, 

45.  254 

Bronchitis              .            ^            ,            .            . 

142 

Bronchocele     ,. 

, 

92 

Bubo           ...            .            .            .           83 

92. 

115,  140 

Bucnaemia        ..... 

. 

143 

Bulimia       ...... 

102,  114 

Cachexiae  .            .           .          83,  104,  108. 

112, 

117,  127 

Caeliaca 

.      103 

Calculus            .            .            ... 

. 

133 

Caligo         .            ,            .            ... 

98, 

ii3»  150 

Callus                .           ,.            . 

• 

163 

Calorineses            ...... 

.      119 

Cancer               .           „,            .            ,                83, 

92, 

115.  336 

Carbuncle               ...            .            . 

.       83 

Carcinoma        .            . 

, 

49,  105 

Carcinus     . 

146 

Cardialgia         ,          .  ,            ,           .  ,            ,       ' 

loi,  132 

Cardiogmus          .  . 

100 

Carditis              .            ,            .            .              96, 

109, 

123,  142 

Caries          .            ,            ,            .          , . 

94. 

-116,  147 

Carphologia    . .          , ,            , 

.    , 

97 

Carpotica 

.     157 

Caruncula         ..... 

, 

163 

Carus          .            .            .            .            , 

83.99 

Catacausis 

, 

146 

Catalepsia 

.      154 

Catalepsis        ,. .          ,. . 

. 

99 

Cataphora 

83.99 

INDEX. 


387 


Catarracta               .            . 

98,  150 

Catarrhus           .             .             . 

loo,  no,  124,  143 

Catoche      .            ... 

.        83 

Catochus            .            .            , 

...            .             97 

Catotica      .             ... 

.      160 

Cenotica            .            .            . 

....           154 

Cephalaea                .            . 

.            •          100,  154 

Cephalalgia        .            .            .   \ 

100 

Cephalitis     .            .            . 

96,  142 

Chancroid  ulcer 

49 

Chirurgery,  master  in 

41 

Chlorosis            .            .            . 

106,  III,  156 

Cholaemia    . 

46,  266 

Cholera                .   _         , 

.   .         84,  103,  III,  133 

Cholesteraemia         .            .            . 

...               266 

Chololithus         .            , 

135 

Choloses 

.            .               165 

Chondroma 

48 

Chorea          .            .            .            . 

.        III.  153 

Cibaria 

132 

Cinetica 

152 

Clasis       .... 

128 

Classification  of  medicine     . 

•            •                 31 

Classification       .            , 

212 

Classification,  basis  of 

214 

"           ,  method  of 

.237 

"           ,  need  of 

.  ,          •               213 

Claudicatio 

97 

Clavus 

.       115,163 

Clonici  generates 

.,          .           .97 

Clonici  partiales        .            .            • 

97 

Clonos      .... 

•            •        126 

Clonus           .            .            .  ^         • 

152 

388 


INDEX. 


Coeliaca                .... 

124,  130 

Colica             .... 

loi,  III,  132 

Coma        ..... 

84,  126 

Comata          .... 

99.  Ill 

Condyloma           .... 

92 

Congestion     .... 

47.  324 

Constrictoria        .... 

125 

Contractura                .            ,            , 

96,  114,  126 

Contusio                .... 

94 

Convulsio       .... 

97.  Ill 

Cophosis               .            ,            ,            . 

98 

Coprostasis                 ,            ,            , 

132 

Coryza       .            .            ,            .            . 

.      84,  103,  136 

Crampus        .... 

96 

Cretinismus          .... 

159 

Crichton's  system 

122 

Critici        .             .             .             .             , 

107 

Cullen's  rules              .            . 

180 

Cullen's  synopsis              .            . 

109 

Cynanche        .... 

96,  109,  123 

Cyrtosis                 .... 

.        159 

Cystides           .... 

92 

Cystirrhoea           .... 

124 

Cystis               .... 

128 

Cysts         ..... 

50.  376 

Cystitis             .... 

96,  no,  123,  142 

Cystocele               .            .            .            . 

93 

I>arwm'§  §y8tem 

118 

Debilitates             .            .            .            . 

98,117 

Decrease          .            .            ,            , 

48,  54 

Definition  of  medicine 

29 

Definitions  of  terms  of  classification 

247 

Defluxion               ♦            ,            •            , 

.        84 

INDNX. 

389 

Deformes 

•                        •                         * 

108 

Deformitates 

. 

108 

Degeneration 

. 

48,  327 

Deliria        .... 

. 

102 

Demens 

. 

149 

Demonomania 

. 

102 

Description  and  definition 

•                        •                        • 

226 

Desmoneoplasmata 

. 

48,  371 

Diabetes 

103, 

in,  125 

Dialysis        .... 

. 

.     128 

Diarrhoea, 

84,  103, 

in,  132 

Diastasis      .... 

. 

94,  129 

Dilatation 

. 

48,57 

Diplopia       .... 

• 

.       lOI 

Dipsosis 

. 

131 

Discalorineses 

. 

.     n9 

Disease,  definition   of  . 

. 

43 

,  etymology  " 

. 

•      43 

,  facies         " 

• 

32 

Disorder       .             .            .            . 

. 

.      58 

functional 

• 

51 

Disoxygeneses 

• 

.    n9 

Diuresis 

• 

125 

Dolores         .            .             .            • 

100, 

108,  n/ 

Dolorosi 

. 

107 

Dyalyses       .             .             .            . 

. 

.    n6 

Dysaesthesiae 

98.  113 

Dyscinesiae 

•            • 

99,  n4 

Dysecoea 

. 

98,  113 

Dysenteria 

84,  103,  no, 

124,  143 

Dysodia 

. 

104 

Dysopia        .            .            .            . 

.           • 

.    113 

Dysorexiae 

• 

n4 

390 


INDEX. 


Dyspepsia 

Dyspermatismus 

Dyspermia 

Dysphagia 

Dysphonia 

Dysphoria 

Dyspnoea 

Dysthetica 

Dystocia 

Dysuria 

ficchymoma 

Ecchymosis 

Eccritica 

Eccyesis 

Echmasis     . 

Eclampsia 

Ecphlysis 

Ecphronia 

Ecphyma 

Ecpyesis 

Ecstasis 

Ectasis 

Ecthyma 

Ectopiae 

Eczema 

Effera 

Efflorescentiae 

Elcosis 

Elephantiasis 

Emboh'smus 

Emesis 

Empathema    ■ 

Emphlysis 


. 

Ill,  132 

. 

104 

,  115,  126 

• 

• 

.  156 

lOO, 

114 

125,  131 

• 

•  137 

• 

153 

84. 98, 

III, 

125,  138 

• 

145 

.   lOI 

84, 

104, 

115,  126 
9h  115 

• 

85,  127 
.  159 

• 

, 

158 
48,57 

• 

• 

97 
162 

• 

. 

148 
163 

• 

^ 

163 
99.  154 

• 

. 

48,57 
163 

93. 

116, 

128,  129 
162 

• 

• 

95 

91.  125 

106 

105,  ] 

ti3.  146 

. 

47»  326 

132 

• 

. 

148 

. 

145 

INDEX, 

391 

Emphyma 

«                        •                        -• 

•        159 

Emphysema 

•                        •                      <  • 

92,  128,  160,  142 

Emprosthotonos 

•                        •                        « 

.          85 

Empyema 

•                        •                        • 

85,  98,  109 

Empyesis 

t                        •                        • 

.       145 

Enanthesis 

144 

Encephalocele 

•                        •                        • 

93 

Endothelioma 

48 

Enecia 

• 

140 

Enlargement 

47.  52 

Entasia 

«            •            • 

.       152 

Enterica 

130 

Enteritis     . 

. 

96,  109,  123,  142 

Enterocele 

93 

Enterolithus 

.      133 

Enteroses 

165 

Enuresis     . 

103,  115 

Epanetus 

139 

Ephelis 

91.  164 

Ephemera 

.      94.  139 

Ephialtes    . 

97.  138 

Ephidrosis 

. 

103,  115,  161 

Epichrosis 

164 

Epilepsia 

. 

75.  97.  Ill 

Epinyctides 

•       85 

Epinj'ctis 

1             •            • 

91 

Epiphora     . 

•            •            •            • 

103,  115 

Epiplocele 

. 

93 

Epiploitis 

»         -   •            •            • 

.      96 

Epischeses 

•            •            • 

57,  108,  115,  125 

Epistaxis 

•            <            •         - 

.    no 

Epithelioma 

»            1             » 

49 

Equinia 

•        '    •            •        ' 

.      49 

392 


INDEX. 


Erotomania 

127 

Erysipelas                  .            , 

85,  95,  no,  144 

Erythema 

92,  124,  141 

Eschara        .             . 

.      94 

Ethmoplecoses 

165 

Evacuatorii 

.    108 

Exangia 

147 

Exania          .             .             .             . 

93.  134 

Exanthemata     . 

no,  n7,  125 

Exanthematica 

95,  107,  144 

Exanthesis 

162 

Exarthrema 

.      94 

Excoriatio 

94 

Excrescentiae 

.      92 

Exocyste 

.    93,  128 

Exomphalus              , 

.      93 

Exophthalmia                 .            , 

93 

Exormia 

.    162 

Exostosis 

92,  n6,  124,  159 

Extractives 

.    294 

Exulceratio 

94 

FacuUy,  definition  of 

.     70 

Farr's  system     . 

174 

Favi 

.     85 

Feb  res 

94,  108,  109, 117 

Fibroma 

48,  371 

Fissura 

94 

Fistula 

86,94 

Flatus     ,            .            .            . 

132 

Fluxus 

102,  117 

Foreign  bodies 

50 

Fractura 

94,  116 

Framboesia 

105,  n3 

INDEX. 

393 

Function,  definition  of 

.    66 

Functional  disorders 

.     51.  59 

Furor              .             .             .             . 

156 

Furunculus 

92.  141 

Oalaetia 

155 

Galactirrhoea       .            .            . 

104 

Ganglion         .            .            .            . 

115 

Gangraena 

86,  106,^09,  147 

Gangrene,  humid  and  dry     . 

.     '          48 

Gasterocele 

93 

Gastritis          .             ,             .             . 

96,  109,  123,  142 

Gastrodynia 

V                   .                    .101 

Gastroses        .            .            .            . 

165 

Generic  characters 

188 

Generic  names 

191 

Genetica 

.     154 

Genetic  sense 

26 

Gibbositas             .            . 

92 

Glanders 

49 

Glaucoma              ,            • 

S6 

Glaucosis 

150 

Glioma      .... 

48,  371 

Gonorrhoea     . 

86,  I04,jii5,  124 

Good's  system 

.       130 

Gout 

.            .           .              86 

Graviditas 

104 

Green  sickness 

86 

Gutta  rosea 

91 

Haeman  gioma 

.      49.  372 

Haematemesis 

103 

Haematica       .            ,            » 

139 

Haematuria           . 

103,  125 

Haemodiapedisis 

.       47,  325 

394 


INDEX. 


Haemoptysis 

t            •           •  -         *            t 

102,  no 

Haemorrhagia 

.47,  86,  102,  no, 

125.  145.  325 

Haemorrhois 

•                         •     -                    •    -                    m    -,                   • 

86,  103,  no 

Hallucinatio     . 

•                        •                        •                        « 

.     loi,  127 

Hectica 

•                        •                        •                        •                        . 

95,  109 

Helminthia      .  , 

•                        •    ^                   .                        . 

133 

Hemicrania 

•                        •                        •                        •                        • 

100 

Hemiplegia 

99 

Hepatalgia 

•  '                     •                        *  9                    •                        • 

lOI 

Hepatirrhoea 

»■-                     •                       •                        • 

103 

Hepatitis 

96, 

109,  123,  142 

Hepatocele 

93 

Hernia 

•                        •                        •                        •-                     • 

116,  128 

Herpes 

86 

,  91,  116,  162 

Hidroa 

•           •            •            •            • 

91 

Hippocrates,  diseases  upon  which  he  has  written 

82-91 

Hordeolum 

92,  141 

Hosack's  system 

»           »           »-           • 

i66 

Hydatis 

93.  1 16 

Hydrarthrus     . 

•                                                       •                                                       ((N                                                *     - 

93,  n6,  144 

Hydrocele   , 

ii3»  128 

Hydrocephalus 

.    105,  n2 

Hydrogeneses 

.      n9 

Hydrometra    . 

.     105,  n3 

Hydrophobia 

102,  112 

Hydrops 

160 

Hydrorhachitis 

105,  n2 

Hydrothorax 

.      98,  113 

Hygiene 

.       35 

Hyperaemia     . 

.      45.  254 

Hyperaestheses 

.      108 

Hyperalonaemia 

.      45.  259 

Hypercholesteraemia        »           ..           .            . 

46,  266 

INDEX. 


395 


Hyperchromataemia 

Hypererythrocythaemia 

Hyperglycaemia 

Hyperinosaemia 

Hyperhydraemia 

Hyperleucocythaemia 

Hyperleucontaemia 

Hyperlipaemia 

Hyperphysaemia 

Hypersarcosis 

Hypertrophy  and  Hypotrophy 

Hyperuraemia 

Hyperuricaemia 

Hypoaemia 

Hypoalonaemia 

Hypocholesteraemia 

Hypochondriasis 

Hypochromataemia 

Hypoerythrocythaemia 

Hypoglycaemia 

Hypohydraemia 

Hypoinosaemia 

Hypoleucocythaemia 

Hypoleucontaemia 

Hypolipaemia     . 

Hypophysaemia 

Hypostophyle     . 

Hypouraemia 

Hysteralgia 

Hysteria         .  , 

Hysteritis 

Hysterocele 

Hysteroloxia 


•      45.  259 

46,  261 

.      46,  263 

45.  257 
.      45.  257 

46,  260 
.      45.  258 

46,  262 

.     46,  262 

.      S6 

53.  55.  326 

46,  265 

.     46,  265 

45.  255 
.     45.  259 

46,  266 

lOI,   III 

46,  260 

.    46,  261 

46,  264 

.    45.257 

45,  258 

.    46,  261 

45.  259 
.    46,  262 

46,  262 

93 
46,  265 

lOI 

97,  112 
10  124,  143 

•    93 
93 


390 

INDEX. 

Hysteroptosis 

93 

Icterus 

.            .            •            • 

113'  134 

Icthyiasis 

162 

Ileus 

. 

103,  132 

Impetigines 

105,  113 

Impetigo 

. 

127,  163 

Impotens 

S7,  156 

Infiltration 

.            .            •            • 

48.  328 

Inflammation 

47,  51,  52,  123 

Inoma 

.            • 

48,  371 

International  Medical  Congress, 

questions  s 

uggested  for  discussion  by 

244 

Intumescentiae 

.    104,  112,  128 

lonthus 

141 

Ischaemia 

47,  323 

Ischias 

lOI 

Ischuria     . 

105,  115,  125 

Lagnesis     . 

156 

Laryngismus 

137 

Laryngitis 

142 

Lassitudo 

100 

Laxarthrus 

94 

Leiomyoma 

49»  372 

Leipopsychiae 

99 

Leipothymia 

99 

Leontiasis 

105 

Lenticula 

164 

Lepidosis 

162 

Lepra 

.     49,105,113 

Lepriasis 

162 

Leprosy 

.         87 

Lethargus        , 

.       99»  154 

Lethargy 

.        87 

INDEX. 


397 


Leucaemia 

Leucasmus 

Leucoma 

Leucomnines 

Leucophlegmatia 

Leucorrhoea 

Leucorrhois     . 

Leucoses 

Lichen 

Lienteria     . 

Limosis 

Lipoma 

Lissa     .  , 

Lithia 

Lordosis 

Loxia 

Lues 

Lumbago     . 

Lupia     . 

Luxatio 

Lymphangioma 

Lymphexosmosis     . 

Lymphorrhagia 

]%Iacbride'§  system 

Macies 

Maculae 

Madness 

Malasicterus 

Malis 

Mania 

Marasmus 

Marcores 

Marisca 


260 
164 

91 

286-296 

87 

104,  124,  155 

124 

.       165 

162 

87»  103.  133 

131 

48,  334 

152 

.     161 

92 
.     152 

146 
.     loi 

.     93»  115 

87,  116,  128 

•     49.  372 

47,  325 

.     47,  325 

.    117 

104 

91,  127 

87 

.     106 

105,  163 

102,  112,  148 

145 

112 

93,  134 


398 


INDEX. 


Mastodynia 

•     ■        •            • 

lOI 

Means 

•             •     •        . 

•     135 

Medicine,  definition  of 

29 

,  classification  of 

•      31 

and  surgery 

39 

Meiosis 

.    48,  54.  327 

Melaena 

.     '       . 

103.  134 

Melanaemia 

46,  267 

Melancholia 

,             , 

.      *      S7, 

102,  112,  148 

Melasma 

.    127 

Membranaceae 

•            t 

96 

Menorrhagia 

,  , 

103,  no 

Mentales 

.             , 

107 

Mesotica 

.    159 

Metamorphoses, 

retrograde 

48 

Meteorismus 

^           J 

105 

Metritis     . 

»            • 

96 

Miliaria 

, 

95,  no,  144 

Milium 

•            •  ' 

162 

Monsters 

50 

Moria     . 

•            • 

149 

Morbositas 

127 

Morositates 

°         •            ■ 

102 

Motorii 

108 

Mutitas 

•  ''         • 

.  99. 114 

Myoma 

•           < 

49.  372 

Myxoma 

. 

48 

]Vau§ea 

103 

Necrosis 

•  '          •  ■ 

.      '      48, 

106, 147,  327 

Neoplasmata 

.        48 

49»  328-372 

Nephralgia 

• '           « 

lOI 

Nephritis      , 

.      k 

no,  123,  142 

Neuralgia 

•            • 

151 

INDEX 


Neuroglioma 

Neuroma 

Neuroses 

Neurotica 

Nictitatio 

Nomenclature,  character  of 

Nosography,  origin  of 

Nostalgia 

Nyctalops 

Nymphomania    .  , 

Nystagmus 

Obstipitas 

Obstipatio 

Obstruction         ,  . 

Odontalgia     . 

Odontia 

Oedema  ,  . 

Oneirodynia 

Ophthalmia 

Opisthotonos 

Oppressivae 

Orchitis 

Organ,  definition  of 

Orgastica  .  , 

Orthopnea 

Oscedo 

Oscheocele     .  , 

Osteoma  .  . 

Osthexia        .   .         ,   - 

Ostocopus    ^        ,    o        . 

Otalgia  .  , 

Otitis 

Otorrhoea      ,  , 


399 


48, 

371 

49. 

372 

III 
148 
152 

227 

. 

74 

102, 

114 

. 

88 

.   I02, 

114, 

127 
97 

. 

96 

115. 

125 

.  49,  57 

lOO, 

no, 

124 
130 

• 

92 

. 

112 

oo,  109, 

123, 

143 

, 

88 

. 

98 

• 

143 

. 

63 

• 

156 

88,98 

• 

97 

. 

93 

• 

48 

160 

• 

100 

100 

• 

142 

104 

400 


INDEX. 


Oxygenases 
Pa  I  pita!  io 

Pandiculatio 

Panophobia 

Parabysma 

Paracusis 

Paracyesis 

Parageusis     . 

Paraglossa 

Paralysis 

Paramenia 

Paramorphiae 

Paraneurismi 

Paranoiac 

Paraphonia 

Paraphrenitis 

Paraph  legia 

Paraphrosyne 

Parapsis 

Parasites 

Pareccrises 

Parenchymatosae 

Parhaemasiae 

Paristhmitis 

Parodynia 

Paroniria 

Paronychia 

Paropsis 

Parorchydium 

Parosmis 

Parostia 

Parotis 

Parotitis     . 


119 

97,  III,  152 

97,  152 

102 

135 

98,  113,  150 

157 
151 

93 

99,  III,  154 

154 
129 
129 
108,  127 

99,  114 
96 

99 

102 
.       151 
50 
129 
96 
129 
142 
.        158 
149 
92,  141 
149 
93 
150 

•       159 

92 

142 


INDE 

X. 

401 

Parr's  rules     . 

185 

Parr's  system 

122 

Paruria 

161 

Pathengenetic  and  pathogenetic 

56,  326 

Pathology 

34 

Pemphigus 

95. 

no,  144 

Periostea 

124 

Peripneumonia 

88,96 

Peritonitis 

109,  142 

Pernio 

142 

Pertussis 

in 

Pestis 

•             • 

95. 

no,  145 

Petechia 

127 

Phaenigmus 

106,  127 

Phallic  worship 

26 

Phimosis 

92 

Phlegmasia     . 

47.  52 

Phlegmasiae 

87,  95. 

109, 

117.  123 

Phlegmatia 

104,  128 

Phlegmon 

123 

Phlegmone 

92,  140 

Phlogistici 

.       107 

Phlogosis 

109,  124 

Phlogotica 

140 

Phlyctaenae     . 

88 

Ph  lysis       .            .            .            . 

141 

Phonica 

136 

Phosphoreneses 

n9 

Phrenica 

148 

Phrenitica 

124 

Phrenitis 

.     88 

,  96, 

109,  123 

Phthinasis 

• 

106 

Phthisis 

104, 

no, 

124,  146 

402 

INDEX. 

Phyma 

92,  141 

Physconia 

.      104,  113 

Physician,  the  ideal 

42 

Physocepiialus  ^ 

105 

Physometra 

105,  112 

Pica     . 

102,  114,  132 

Pinel's  system 

.        118 

Pityriasis 

162 

Plagae 

.     94,  117,  128 

Plague 

.            .               88 

Plethora     . 

145.  254 

Pleuralgia 

138 

Pleurisy     . 

88 

Pleuritis 

96,  142 

Pleurodyne 

.        9» 

Plica     . 

163 

Pneumatica 

136 

Pneumatosis     . 

•            .    104,  112 

Pneumonia 

109,  123 

Pneumonica 

.    124,  137 

Pneumonitis 

142 

Pneumoses 

165 

Podagra     . 

no,  144 

Poecilia 

164 

Polypus 

.     88,  125,  136 

Polydipsia 

.    102,  114 

Polysarcia 

104,  112,  159 

Pompholyx 

162 

Porphyra 

. 

.       147 

Porrigo 

163 

Priapismus 

.    96,  126,  152 

Proctalgia 

lOI 

Proctica     . 

•       134 

INDEX. 


405 


Proeotica 

156 

Profluvia                .            .            *            • 

108,  125 

Profusio            .... 

"5 

Prolapsus              ',            ,            .            . 

116,  128 

Prophylaxy       .... 

35 

Proptoma               .            .            .            . 

93 

Prurigo              .             .             .             • 

162 

Pruritus      .            ,            .            .            . 

100 

Psellismus        .           -.            .            . 

99. 

114,  137 

Pseudoblepsis 

•      113 

Pseudocycsis 

158 

Psora          .            .            . 

.     116 

Psoriasis           .... 

162 

Psydracia                ... 

.       91 

Pterygium 

88,  92 

Ptomaines 

267-286 

Ptyalismus        .            .            .            • 

103. 

115.  131 

Pudendagra 

.        lOI 

Puerperalis       .            ,            .            • 

124 

Punctura     . 

.       94 

Purpura             ,             .             , 

95 

Pyosapraemia 

46,  297 

Pyretica 

139 

Pyrexiae      .             .             ,             . 

109,  123 

Pyrosis              .            .            , 

100,  III 

Pyuria 

.     104 

Qiiietale§     . 

108 

Quinsey       .            .            .            . 

.       89 

Rai^e-Delorme's  system 

i66 

Raphania    .... 

III,  153 

Recamier's  system       .         -■  ,            , 

121 

Rhabdomyoma 

49»  372 

Rhachia            .            .            , 

159 

404 


INDEX. 


Rhachialgia  .  . 

Rhachitis  .... 

Rhagas        .... 
Rheum  .... 

Rheuma       .... 
Rheumatismus 
Rhinoscleroma 

Rhonchus  .  .  ,  , 

Rhypia         .... 
Richerand's  system        .  .  . 

Rigor  .... 

Rosalia  .... 

Roseola        .... 
Royal  Coll.  of  Phys.  of  London 
Rubeola       .... 
Rubigo  .... 

Rubula  .... 

Rules  for  the  guidance  of  the  nosographe: 
Ruptura        .... 
Sagar'8  §y§tein 
Salacitas       .  .  ,  , 

Oaid-X  •  •  •  a  • 

Sanguifluxus 

Sarcoma  .... 

Satyriasis      .... 

Sauvages,  notice  of        . 

Savignac's  system 

Scabies  .... 

Scarlatina      .... 

Scelotyrbe  .... 

Sciatica,         .... 

Scirrhus  .... 

Scorbutus      .... 


48, 


loi,  132 

105, 113 

.   94 

89 

.   98 

100,  no 

49.  374 

136 

.  162 

129 

.   97 

144 

162 

175 

95. 

no,  144 

127 

145 

180 

94 

116 

156 

149 

102 

92, 115. 

159.  365 

102, 

114.  127 

76 

173 

105,  163 

95,  no 

97 

89 

. 

92,  us 

105, 

113.  127 

INDEX. 

40s 

Scrophula 

105,  113 

Scurvy 

. 

.      89 

Scybalum 

133 

Selle's  system 

• 

117 

Septicaemia          .            , 

46,  267 

Serifluxus       .             . 

103 

Singultus 

98,  152 

Sinus 

94 

Somnambulismus 

lOI 

Spasmi 

'96, 

108, 

III,  117,  126 

Spasmodicae 

97 

Specific  differences 

194 

Spermorrhoea      .            . 

155 

Sphacelus 

89,  109,  147 

Spilus       . 

164 

Splanchnica 

134 

Splenalgia 

lOI 

Splenitis 

96,  no,  142 

Splenocele 

93 

Staphyloma 

93.  150 

Stark's  system 

173 

Stenosis 

48,  56 

Sternalgia 

.       138 

Sternutatio 

97,  152 

Stertor 

89,98.  136 

Stomacace 

103 

Stones       .            , 

50,  89 

Strabismus 

yu, 

114,  126,  150 

Strangury 

.        89 

Stricture 

•            • 

• 

48,  56 

Strophulus 

162 

Struma 

• 

• 

146 

Stupor       .            , 

,       100 

406                                       INDEX. 

Suffusio 

lOI 

Supercalorineses 

.119 

Superoxygeneses 

119 

Suppressiones 

.117 

Suppressorii    . 

.            .            .     108,  125 

Surditas      .... 

.            .            .      150 

Swediaur's  system 

.            .            .            129 

Sycosis       .... 

.      141 

Synclonus 

153 

Syncope      .... 

99.  Ill 

Synocha 

94.  109,  123 

Synochus 

94,  109,  123,  140 

Synonyms         .             .             .             . 

198 

Synopsis  of  Cullen 

.109 

Synopsis,  of  morbid  states,  etc. 

.               ;                  45 

Syphilis        .             . 

49, 105, 113, 127, 146 

Syphilodes        .            .            ,            , 

146 

Syrogmos                •            • 

.       lOI 

Systatica           .            .            .            , 

153 

Systremma              .            , 

.    152 

Tabes            •           .           .           , 

104,  112,  146 

Tabes  dorsales 

...         90 

Tarantismus    ,            .            .            . 

102 

Tenesmus 

90,  103,  134 

Teratology       .            .            .            . 

34 

Terminthi                . 

•       90 

Tetanus             .             .             .             , 

90,97,  III,  126,  152 

Tetartophya 

.            .95 

Therapy            .            .            .            , 

.           .             36 

Thrombosis            .            • 

47.325 

Tinea                .            .            . 

105,  116 

Tonici  generales    . 

.       97 

Tonici  partiales            .            ,            . 

96 

] 

[NDEX.                                        407 

Tourdes'  system     , 

.120 

Tourtelle's  system  . 

.......           121 

Tricoma 

.106 

Trichosis           .            • 

.     90.  163 

Tremor       .            ,            . 

97.  III.  153 

Trismus 

96,  III,  126,  152 

Tritacophya            .            • 

.      95 

Trophopathies              • 

165 

Tuber 

.     128 

Tubera              •            • 

105 

Tuberculosis 

.       49 

Tuffls 

98 

Tumors      .            .            • 

.       90 

Tympanites 

.    105,  112 

Typhomania 

99 

Typhus, 

95.  109.  123,  140 

Ulceration 

48 

Ulcers 

.            ...              90 

Ulcus 

.    94,116,147 

Ureses             • 

165 

Urticaria     . 

no,  144 

Taccinia 

.            .            .            144 

Vagi 

,            .           .            .           .     100 

Varicella 

no,  144 

Varieties     . 

.     198 

Variola 

95.  no.  H5 

Varix           •            . 

90,92,  us,  147 

Verruca 

92.115.163 

Vertigo 

91.  loi 

Vesaniae           ,            . 

loi,  n2,  117,  127 

Vitet's  system 

.117 

Vitia     . 

91]  108.  117 

Vitiligo 

91 

408  INDEX. 

Vomica  •           •           •           •           •               109,  140 

Vomitus  •••••••     103 

Vulnus  •           •            •            •           •            .     94,  116 


Angell's  Pnnting  Office,  354  Fourth  Ave.,  N.  Y. 


409 


WORKS  BY  THE  SAME  AUTHOR. 


A  CASE  OF  POLYPUS  OF  THE  LARYNX. — Tracheotomy  to 
prevent  impending  suffocation  ;  laryngo-tracheotomy ; 
recurrence  of  the  disease ;  operation  repeated  ;  recovery. 
New  York  Medical  Journal,  September  1867. 

On  external  perineal  urethrotomy,  or  an  improved 
method  of  external  division  of  the  urethra  in  perinaeo 
for  the  relief  of  obstinate  stricture,  etc.  Transactions  of 
the  Medical  Society  of  the  State  of  Nev^  York,  1869. 
New  York  Medical  Journal,  August  1S69.  Reprinted 
in  pamphlet  form,  pp  32. 

Instruments  for  exploration  of  the  urethra, — 
Difficult  catheterism,  etc.  Medical  Record,  March  15th, 
1870. 

Treatment  of  intractable  (urethral)  strictures. 

Divulsion  and  divulsors,  etc.    Medical  Record.  April  ist, 
1870. 

On  internal  urethrotomy.  Medical  Record.  April 
I5lh,  1870, 

Strictures  at  the  meatus  urinarius,  and  in  the  fossa 
navicularis.  Their  nature,  diagnosis  and  treatment. 
Medical  Record.  May  2d,  1870. 

On  MODERN  lithotripsy.  Medical  Record.  October  ist, 
1870. 


4tO 

Urethral  fever  from  catheterism,  its  nature  and  treat- 
ment.   Medical  Record.     October  ist,  1872. 

Case  of  retention  of  urine  caused  by  a  single,  diseased 
kidney,  situated  in  the  pelvic  cavity,  for  tiie  relief  of 
which  rectal  puncture  was  done.  The  trocar  passing  to 
the  right  of  the  bladder  and  entering  the  kidney.  Death 
on  the  fourth  day  after  the  operation.  Autopsy.  Re- 
marks.    Medical  Record.     October  I5ih,  1872. 

Rupture  of  the  bladder  from  retention  of  urine  due  to 
.stricture  of  the  urethra.  With  cases  and  remarks. 
Medical  Record.    November  ist,  1872. 

Diseases  of  the  urinary  organs,  including  stricture  of 
the  urethra,  affections  of  the  prostate  and  stone  in  the 
bladder.     1873.     8vo  pp  368. 

Perityphlitic  ABSCESS  due  to  perforation  of  the  appendix 
vermiformis,  with  remarks  on  the  surgical  treatment 
thereof.  Transactions  of  Medical  Society  of  the  State  of 
New  York,  1875.  Virginia  Medical  Monthly.  March 
1875.     Pamphlet  pp  9. 

Treatment  of  chronic  cystitis.  Abstract  of  a  paper 
read  on  this  subject  to  the  Medical  Society  of  King's 
County,  New  York.  Medical  Record.  October  30th, 
1875. 

Urethroplastic  operations  to  remedy  hypospadias, 
epispadias  and  incurvation  of  the  penis.  Medical  Record. 
February  19th,  1876.     Pamphlet  pp  15. 


411 

Stone  in  the  bladder,  its  spontaneous  expulsion  and  its 
removal  by  lithotripsy,  lithotomy  and  perineal  lithotrity, 
with  an  analysis  of  thirty-five  cases.  Abstract  of  paper 
read  to  Medical  Society  of  the  State  of  New  York,  June 
1876.     Medical  Record.     July  8th,  1876. 

Report  of  a  case  of  sub-periosteal  excision  and  dis- 
articulation of  the  entire  inferior  maxillary  bone  for 
phosphorous  necrosis.  Pamphlet  pp  6.  Extracted  from 
the  Transactions  of  the  International  Medical  Congress, 
Philadelphia.     September  1876. 

Amputation  of  the  penis.  Cases  illustrative  of  the  man- 
agement of  the  extremity  of  the  urethra  after  amputation 
of  the  penis  close  to  the  pubes.  Louisville  Medical 
News.     September  15th,  1877. 

Retention  of  urine  in  elderly  men.  Acute  retention 
of  urine.    Medical  Record.     August  23rd,  1879. 


Internal  urethrotomy  and  lithotripsy  at  the  same  sit- 
ting, etc.  With  remarks  on  rapid  lithotripsy,  and  on  the 
evacuation  of  detritus  from  the  bladder.  Pamphlet  pp  16. 
Reprinted  from  the  Medical  Record.  October  i8th, 
1879. 

Note  on  CYSTORRHagia  from  retention  of  urine.  Pamphlet, 
pp  15.  Reprinted  from  the  Transactions  of  the  Medical 
Society  of  the  State  of  New  York  for  1880.  and  published 
in  ihc  Medical  Record.     February  21st,  1880, 


Chronic  retention  of  urine  in  elderly  men.  Pro- 
ceedings of  the  Medical  Society  of  the  County  of 
Kings.    Vol,  VI,  January  1882. 

A  CLINICAL  contribution  to  lithoclastic  cystotomy,  with 
eleven  illustrative  cases.  The  Medical  Gazette.  Nev^r 
York,  June  2d,  1883. 

Report  of  a  case  of  ligature  of  the  right  prim- 
itive ILIAC  artery  for  diffuse  aneurism  of  the  external 
iliac;  death  from  pyaemia  on  the  twenty-first  day. 
Transactions  of  the  New  York  State  Medical  Association. 
1884. 

Some  points  in  the  surgery  of  the  hypertrophied 
prostate.  Transactions  of  the  American  Surgical 
Association.  1885. 

Notes  on  contracture  of  the  bladder  consequent 
upon  cystitis.  Transactions  of  the  New  York  State 
Medical  Association.  1885. 

Sacculation  and  perforation  of  the  bladder  as 
consequences  of  chronic  retention  of  urine.  Pamphlet 
pp  14.  Reprinted  from  the  Transactions  of  the  New 
York  State  Medical  Association.  1 886. 


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